Methods and compositions for reducing heparan sulfate proteoglycan-mediated clearance of factor viii

ABSTRACT

The present invention provides methods of increasing the half-life factor VIII. More specifically, the invention methods of increasing the half-life of factor VIII by substituting amino acids in the A2 domain or in the C2 domain of factor VIII or in both domains. It further provides factor VIII mutants produced by these methods. The invention also provides a method of using receptor-associated protein (RAP) to increase the half-life of factor VIII. The invention also provides polynucleotides encoding the mutant factor VIII, polynucleotides encoding RAP, and methods of treating hemophilia using the polypeptides and polynucleotides of the invention.

STATEMENT AS TO RIGHTS TO INVENTIONS MADE UNDER FEDERALLY-SPONSORED RESEARCH AND DEVELOPMENT

[0001] Part of the work performed during development of this invention utilized U.S. Government funds. The U.S. Government has certain rights in this invention.

BACKGROUND OF THE INVENTION

[0002] 1. Field of the Invention

[0003] This invention relates generally to a mutant factor VIII having increased half-life, methods of production, pharmaceutically acceptable compositions and uses thereof. This invention also relates to a method of using receptor associated protein to increase the half-life of factor VIII, methods of production, pharmaceutically acceptable compositions and uses thereof.

[0004] 2. Related Art

[0005] Coagulation of blood occurs by either the “intrinsic pathway” or the “extrinsic pathway,” whereby certain blood proteins interact in a cascade of proteolytic activations to ultimately convert soluble fibrinogen to insoluble fibrin. These threads of fibrin are cross-linked to form the scaffolding of a clot; without fibrin formation, coagulation cannot occur.

[0006] The intrinsic pathway consists of seven steps: (1) the proteolytic activation of factor XII; (2) activated factor XII cleaves factor XI to activate it; (3) activated factor XI cleaves factor IX, thereby activating it; (4) activated factor IX interacts with activated factor VIII to cleave and activate factor X; (5) activated factor X binds to activated factor V on a membrane surface, which complex proteolytically cleaves prothrombin to form thrombin; (6) thrombin proteolytically cleaves fibrinogen to form fibrin; (7) fibrin monomers assemble into fibrils, which are then cross-linked by factor XIII.

[0007] The extrinsic pathway consists of the following steps: (1) upon rupture of a blood vessel, factor VII binds to tissue factor, a lipoprotein present in tissues outside the vascular system; (2) factor VII is activated to factor VIIa by proteolytic cleavage; and (3) the factor VIIa-tissue factor complex cleaves and activates factor X. Thereafter, the extrinsic pathway is identical to the intrinsic pathway, i.e. the two pathways share the last three steps described above.

[0008] The plasma glycoprotein factor VIII circulates as an inactive precursor in blood, bound tightly and non-covalently to von Willebrand factor. Factor VIII (fVIII) is proteolytically activated by thrombin or factor Xa, which dissociates it from von Willebrand factor (vWf) and activates its procoagulant function in the cascade. In its active form, factor VIIIa (fVIIIa) functions as a cofactor for the factor X activation enzyme complex in the intrinsic pathway of blood coagulation, and it is decreased or nonfunctional in patients with hemophilia A.

[0009] In hemophilia, blood coagulation is impaired by a deficiency in certain plasma blood coagulation factors. People with deficiencies in factor VIII or with antibodies against factor VIII suffer uncontrolled internal bleeding that may cause a range of serious symptoms unless they are treated with factor VIII. Symptoms range from inflammatory reactions in joints to early death. The classic definition of factor VIII, in fact, is that substance present in normal blood plasma that corrects the clotting defect in plasma derived from individuals with hemophilia A. A deficiency in vWf can also cause phenotypic hemophilia A because vWf is an essential component of functional factor VIII. In these cases, the half-life of factor VIII is decreased to such an extent that it can no longer perform its particular functions in blood-clotting.

[0010] The fVIII protein consists of a homologous A and C domains and a unique B domain which are arranged in the order A1-A2-B-A3-C1-C2 (Vehar, G. A., et al., Nature 312:337-340 (1984)). It is processed to a series of Me²⁺ linked heterodimers produced by cleavage at the B-A3 junction (Fay, P. J., et al., Biochem. Biophys. Acta. 871:268-278 (1986)), generating a light chain (LCh) consisting of an acidic region (AR) and A3, C1, and C2 domains and a heavy chain (HCh) which consists of the A1, A2, and B domains (FIG. 1).

[0011] Activation of fVIII by thrombin leads to dissociation of activated fVIII (fVIIIa) from vWf and at least a 100-fold increase of the cofactor activity. The fVIIIa is a A1/A2/A3-C1-C2 heterotrimer (Fay, P. J., et a., J. Biol. Chem 266:8957-8962 (1991)) in which domains A1 and A3 retain the metal ion linkage (FIG. 1) and the stable dimer A1/A3-C1-C2 is weakly associated with the A2 subunit through electrostatic forces (Fay, P. J., et al., J. Biol. Chem 266:8957-8962 (1991)). Spontaneous dissociation of the A2 subunit from the heterotrimer results in non-proteolytic inactivation of fVIIIa.

[0012] The A2 domain is necessary for the procoagulant activity of the factor VIII molecule. Studies show that porcine factor VIII has six-fold greater procoagulant activity than human factor VIII (Lollar, P., and E. T. Parker 266 J. Biol. Chem. 12481-12486 (1991)), and that the difference in coagulant activity between human and porcine factor VIII appears to be based on a difference in amino acid sequence between one or more residues in the human and porcine A2 domains (Lollar, P., et al., 267 J. Biol. Chem. 23652-23657 (1992)).

[0013] Infusion of fVIII/vWf complex or purified plasma or recombinant fVIII into patients with severe hemophilia A who do not have fVIII (Fijnvandraat, K., et al., Thromb. Haemostas. 77:298-302 (1997); Morfini, M., et al, Thromb. Haemostas. 68:433-435 (1992)) or in normal individuals (Over, J., et al, J. Clin. Invest. 62:223-234 (1978)) results in a similar fVIII disappearance with a half-life of 12-14 hours. Although the complex between fVIII and vWf is crucial for normal half-life and level of factor VIII in the circulation, the mechanisms associated with turnover of fVIII/vWf complex are not well defined.

[0014] The human factor VIII gene was isolated and expressed in mammalian cells (Toole, J. J., et al., Nature 312:342-347 (1984); Gitschier, J., et al., Nature 312:326-330 (1984); Wood, W. I., et al., Nature 312:330-337 (1984); Vehar, G. A., et al., Nature 312:337-342 (1984); WO 87/04187; WO 88/08035; WO 88/03558; U.S. Pat. No. 4,757,006), and the amino acid sequence was deduced from cDNA. Capon et al., U.S. Pat. No. 4,965,199, disclose a recombinant DNA method for producing factor VIII in mammalian host cells and purification of human factor VIII. Human factor VIII expression in CHO (Chinese hamster ovary) cells and BHKC (baby hamster kidney cells) has been reported. Human factor VIII has been modified to delete part or all of the B domain (U.S. Pat. No. 4,868,112), and replacement of the human factor VIII B domain with the human factor V B domain has been attempted (U.S. Pat. No. 5,004,803). The cDNA sequence encoding human factor VIII and predicted amino acid sequence are shown in SEQ ID NOS:1 and 2, respectively.

[0015] U.S. Pat. No. 5,859,204, Lollar, J. S., describes mutants of human factor VIII having reduced antigenicity and reduced immunoreactivity.

[0016] Porcine factor VIII has been isolated and purified from plasma (Fass, D. N., et al., Blood 59:594 (1982)). Partial amino acid sequence of porcine factor VIII corresponding to portions of the N-terminal light chain sequence having homology to ceruloplasmin and coagulation factor V and largely incorrectly located were described by Church, et al., Proc. Natl. Acad. Sci. USA 81:6934 (1984). Toole, J. J., et al., Nature 312:342-347 (1984) described the partial sequencing of the N-terminal end of four amino acid fragments of porcine factor VIII but did not characterize the fragments as to their positions in the factor VIII molecule. The amino acid sequence of the B and part of the A2 domains of porcine factor VIII were reported by Toole, J. J., et al., Proc. Natl. Acad. Sci. USA 83:5939-5942 (1986). The cDNA sequence encoding the complete A2 domain of porcine factor VIII and predicted amino acid sequence and hybrid human/porcine factor VIII having substitutions of all domains, all subunits, and specific amino acid sequences were disclosed in U.S. Pat. No. 5,364,771 by Lollar and Runge, and in WO 93/20093. More recently, the nucleotide and corresponding amino acid sequences of the A1 and A2 domains of porcine factor VIII and a chimeric factor VIII with porcine A1 and/or A2 domains substituted for the corresponding human domains were reported in WO 94/11503. U.S. Pat. No. 5,859,204, Lollar, J. S., discloses the porcine cDNA and deduced amino acid sequences.

[0017] Cellular endocytosis mediated by LRP was shown to be a mechanism of removal of a number of structurally unrelated ligands including several proteins related to coagulation or fibrilolysis. These ligands are: complexes of thrombin with antithrombin III (ATIII), heparin cofactor II (HC11) (Kounnas, M. Z., et al., J. Biol. Chem. 271:6523-6529 (1996)), protease nexin I (Knauer, M. F., et al., J. Biol. Chem. 272:12261-12264 (1997)), complexes of urokinase-type and tissue-type plasminogen activators (u-PA and t-PA, respectively) with plasminogen activator inhibitor (PAI-1) (Nykjaer, A., et al., J. Biol. Chem. 267:14543-14546 (1992); Orth, K., et al., Proc. Natl. Acad. Sci. 89:7422-7426 (1992)), thrombospondin (Mikhailenko, I., et al., J. Biol. Chem. 272:6784-6791 (1997)), tissue factor pathway inhibitor (TFPI) (Warshawskly, I., et al., Proc. Natl. Acad. Sci. 91:6664-6668 (1994)), and factor Xa (Narita, M., et al, Blood 91:555-560 (1998); Ho, G., et al., J. Biol. Chem 271:9497-9502 (1996)).

[0018] LRP, a large cell-surface glycoprotein identical to α₂-macroglobulin receptor (Strickland, D. K., et al., J. Biol. Chem. 265:17401-17404 (1990)), is a member of the low density lipoprotein (LDL) receptor family which also includes the LDL receptor, very low density lipoprotein (VLDL) receptor, vitellogenin receptor and glycoprotein 330 receptor. LRP receptor consists of the non-covalently linked 515 kDa α-chain (Herz, J., et al., EMBO J. 7:4119-4127 (1988)) containing binding sites for LRP ligands, and the 85 kD a transmembrane β-chain. Within the α-chain, cluster of cysteine-rich class A repeats is responsible for ligand binding (Moestrup, S. K., et al., J. Biol. Chem 268:13691-13696 (1993)). In contrast to the acidic ligand binding region in LRP, ligands of LRP expose regions rich in positively charged amino acid residues (Moestrup, S. K., Biochim. Biophys. Acta 1197:197-213 (1994)). This type of binding and 31 class A repeats present in LRP may be responsible for its wide ligand diversity and ability to serve as a multi-ligand clearance receptor. LRP is expressed in many cell types and tissues including placenta, lung and brain (Moestrup, S. K., et al., Cell Tissue Res. 269:375-382 (1992)) and is a major endocytic receptor in the liver (Strickland, D. K., et al., FASEB J. 9:890-898 (1995)).

[0019] A 39 kDa receptor-associated protein (RAP) binds to LRP with high affinity (K_(d)=4 nM (27)) and inhibits binding and LRP-mediated internalization and degradation of all ligands (Moestrup, S. K., Biochim. Biophys. Acta 1197:197-213 (1994);Williams, S. E., et al., J. Biol. Chem. 267:9035-9040 (1992)), therefore serving as a useful tool for testing whether LRP is involved in endocytosis of a given ligand.

[0020] Severe hemophiliacs, who number about 10,000 in the United States, can be treated with infusion of human factor VIII, vWf/factor VIII complex or vWf which will restore the blood's normal clotting ability if administered with sufficient frequency and concentration. However, supplies have been inadequate and problems in therapeutic use occur due to difficulty in isolation and purification, immunogenicity, and the necessity of removing the AIDS and hepatitis infectivity risk.

[0021] Several preparations of human plasma-derived factor VIII of varying degrees of purity are available commercially for the treatment of hemophilia A. These include a partially-purified factor VIII derived from the pooled blood of many donors that is heat- and detergent-treated for viruses but contains a significant level of antigenic proteins; a monoclonal antibody-purified factor VIII that has lower levels of antigenic impurities and viral contamination; and recombinant human factor VIII, clinical trials for which are underway. Unfortunately, human factor VIII is unstable at physiologic concentrations and pH, is present in blood at an extremely low concentration (0.2 μg/ml plasma), and has low specific clotting activity.

[0022] The problems associated with the commonly used, commercially available, plasma-derived factor VIII have stimulated significant interest in the development of a better factor VIII product. There is a need for a more potent factor VIII; a factor VIII that is stable at a selected pH and physiologic concentration; a factor VIII that is has a longer half-life in circulating blood.

SUMMARY OF THE INVENTION

[0023] The present invention relates to a method of increasing the half-life of factor VIII. More specifically, the present invention relates to a mutant of factor VIII having reduced clearance from plasma.

[0024] In one embodiment, the mutant factor VIII has one or more amino acid substitutions in the A2 domain.

[0025] In a preferred embodiment, the substituted amino acid(s) in the A2 domain are important for heparin sulfate proteoglycan (HSPG)-dependent, receptor-independent clearance of factor VIII, such that the resulting mutant factor VIII has a longer (increased) circulating half-life.

[0026] In a preferred embodiment, the substituted amino acid(s) in the A2 domain are important for receptor-dependent clearance of factor VIII, such that the resulting mutant factor VIII has a longer (increased) circulating half-life.

[0027] In another embodiment, the mutant factor VIII has one or more amino acid substitutions in the C2 domain. In a preferred embodiment, the substituted amino acid(s) in the C2 domain are important for receptor-independent clearance of factor VIII, such that the resulting mutant factor VIII has a longer (increased) circulating half-life.

[0028] In yet another preferred embodiment, amino acid(s) important for HSPG-dependent clearance in the A2 domain and receptor-dependent clearance in the A2 domain are substituted, such that the resulting mutant factor VIII has an increased circulating half-life.

[0029] In yet another preferred embodiment, amino acid(s) in the A2 domain important for HSPG-dependent clearance are substituted and amino acid(s) in the C2 domain important for receptor-independent clearance are substituted, such that the resulting mutant factor VIII has an increased circulating half-life.

[0030] In yet another preferred embodiment, amino acid(s) in thc A2 domain important for HSPG-dependent, receptor-independent clearance are substituted, amino acid(s) in the A2 important for receptor-dependent clearance are substituted, and amino acid(s) in the C2 domain important for receptor-independent clearance are substituted, such that the resulting mutant factor VIII has an increased circulating half-life.

[0031] The invention also relates to a method of using receptor associated protein (RAP) to increase the half-life of factor VIII. Further aspects of the invention include a method of producing factor VIII mutants having an increased half-life, pharmaceutically acceptable compositions of such factor VIII mutants, and a method of treating factor VIII deficiency using mutant factor VIII of the invention and/or RAP.

BRIEF DESCRIPTION OF THE FIGURES

[0032]FIGS. 1A-1D. Effect of RAP, heparin and heparinase on ¹²⁵I-fVIII/vWf and ¹²⁵I-A2 surface binding and degradation in mouse embryonic fibroblasts (MEF). Wells containing 2×10⁵ of LRP-expressing MEF cells (solid bars) or LRP-deficient PEA 13 cells (open bars) were preincubated with or without heparinase as described in Example 1. This was followed by addition of either 1 nM ¹²⁵I-fVIII/vWf complex (FIGS. 1A-1B) or 1 nM ¹²⁵I-A2 (FIGS. 1C-1D) in the absence or presence of RAP (1 μM) or heparin (100 μg/ml) and incubation for 6 h at 37° C. Surface binding of ¹²⁵I-fVIII and ¹²⁵I-A2 (FIGS. 1A and 1C) and degradation (FIGS. 1B and 1D) were subsequently determined as described in Example 1. Each data point represents the mean value and standard deviation of duplicate determinations.

[0033]FIGS. 2A-2F. Effect of RAP, heparin and heparinase on surface binding, internalization and degradation of the ¹²⁵I-A2 subunit of fVIII by smooth muscle cells (SMC) and alveolar epithelial cells (T2). Wells containing 10⁵ SMC cells (gray bars) or T2 cells (hatched bars) were preincubated with or without heparinase as described in Example 1. Following incubation of the cells with 1 nM of ¹²⁵I-A2 in the absence or presence of RAP (1 μM) or heparin (100 μg/ml) for 6 hour at 37° C., surface binding (FIGS. 2A and D), internalization (FIGS. 2B and 2E) and degradation (FIGS. 2C and 2F) of ¹²⁵I-A2 were determined as described in Example 1. Each data point represents the mean value and standard deviation of duplicate determinations.

[0034]FIG. 3. Effect of fVIII fragments and vWf on binding of fVIII/vWf complex to the surface of MEF cells. Wells containing 2×10⁵ LRP-expressing MEF cells (solid bars) or control LRP-deficient PEA 13 cells (gray bars) were preincubated with or without heparinase as described in Example 1. One nM ¹²⁵I-fVIII/vWf complex was added to the cells in the absence of any competitor (control) or in the presence of 200 nM each of A2, A1/A3-C1-C2, or vWf and incubated for 2 h at 4° C., and surface-bound radioactivity was determined, as described in Example 1. Each data point represents the mean value and standard deviation of duplicate determinations.

[0035]FIGS. 4A-4B. Determination of parameters for A2 binding to the surface of MEF cells. (FIG. 4A) Direct binding of ¹²⁵I-A2 to MEF cells. The cells were incubated for 2 h at 4° C. with increasing concentrations of ¹²⁵I-A2 in the absence (•) or presence (Δ) of a 100-fold molar excess of unlabeled A2. Specific binding (∘) was calculated by subtraction of the nonspecific binding (Δ) from total binding (•). (FIG. 4B) Displacement of ¹²⁵I-A2 by unlabeled A2, fVIII/vWf complex or vWf. The MEF cells were incubated as above with ¹²⁵I-A2 (2 nM) in the presence of increasing concentrations of unlabeled A2 (□), vWf (Δ) or fVIII/vWf complex (•) formed using varying fVIII concentrations (4-512 nM) and fixed vWf concentration (1000 nM). This was followed by a determination of the ¹²⁵I-A2 binding to the cells. Each data point represents the mean value and standard deviation of duplicate determinations. The curves show a best fit of the data to a model describing homologous or heterologous ligand displacement from a single class of binding sites using the LIGAND program.

[0036]FIG. 5. Binding of fVIII and its fragments to heparin using the SPR technique. Heparin was immobilized to a biosensor chip as described in Example 1. Binding of 500 nM of fVIII (curve 1), HCh (curve 2), LCh (curve 3), A2 (curve 4), and A1 (curve 5) were measured for 5 min at the flow rate of 10 μ/min. Dissociation kinetics were measured upon replacement of the ligand solution by buffer, which was continuously changed at a flow rate of 10 μ/min. The kinetic curves were corrected for nonspecific binding by subtracting the signals obtained in the absence of immobilized heparin, which were less than 6% of the binding to heparin-coated chip.

[0037]FIGS. 6A-6B. Effect of heparin on the A2-dependent factor Xa generation and interaction between A2 and factor IXa. (FIG. 6A) Effect of heparin on the factor Xa generation assay. The mixtures containing factor IXa (5 nM), PSPC vesicles (10 μM), A2 domain (200 nM) and the indicated concentrations of heparin were incubated for 10 min, and the reactions were started by addition of factor X (300 nM). The initial rates of factor Xa generation (Δ) were determined as described in Example 1. (FIG. 6B) Effect of heparin on the interaction of A2 domain and factor IXa. A2 subunit (300 nM) was preincubated for 15 min with the indicated concentrations of heparin. The anisotropy was measured upon addition of PSPC vesicles (50 μM) and FI-FFR-factor IXa (30 nM) in the presence (▪) or absence (•) of factor X (400 nM as described in Example 1. In control experiments, A2 subunit was omitted from the mixtures with (□) or without (∘) factor X. Each point represents the mean value±SD of five measurements.

[0038]FIGS. 7A-7B. Effect of synthetic peptides on A2-heparin binding. (FIG. 7A) Effect of the A2 domain peptide 558-565 on the binding of A2 to heparin was measured by the SPR technique. Heparin was immobilized on the chip surface as described in Example 1. Binding of the A2 subunit (200 nM) to heparin was measured in the absence (curve 1) or presence of varying concentrations of the peptide (25, 50, 100, 200, 400 and 800 μM, curves 2-7, respectively). (FIG. 7B) Effect of A2 peptides 432-456 (Δ), 484-509 (∘) and 558-565 (•) on binding of the A2 subunit to heparin. Equilibrium binding of A2 to immobilized heparin at the indicated concentrations of each peptide was determined as in FIG. 7A. A2 binding in the presence of peptides is expressed as the percentage of the A2 binding when no peptide was added.

[0039]FIG. 8. Effect of protamine on clearance of ¹²⁵I-fVIII/vWf from plasma of mice. BALB/c mice were injected with 100 μl 0.2 mM protamine (Δ) or 150 μM RAP (∘) separately or with 100 μl 0.2 mM protamine and 150 μM RAP in combination (▴) 2 min prior to the injection of 100 μl samples containing ¹²⁵I-fVIII (15 nM) and vWf (750 nM). In the control experiment (•), clearance of ¹²⁵I-fVIII/vWf complex was studied in the absence of any added agent. At the indicated time points, blood samples were taken and counted for radioactivity. The percentage of ligand remaining in circulation was calculated taking the radioactivity of an aliquot taken at 1 min after injection as 100%. ¹²⁵I-fVIII clearance was examined in four mice for each of the above conditions. The curves show the best fit of the experimental data to Equation 1 (see Example 1) describing biphasic exponential clearance of fVIII.

[0040]FIGS. 9A-9L. Microscopy studies of surface binding of fVIII from its complex with vWf by HEP G2 cells. Control untreated HEP G2 cells (FIGS. 9A-9D) and the cells treated with heparinase (FIGS. 9E-9H) or RAP (FIGS. 9I-9L) were incubated with 10 nM of fVIII/vWf complex for 2 h at 4° C. This was followed by fixing the cells and staining for fVIII using Texas Red (red images in FIGS. 9A, 9E, 9I), for HSPGs using AMCA (blue images in FIGS. 9B, 9F, 9G) and for LRP using FITC (green images in FIGS. 9C, 9G, 9K), as described in Example 1. Each type of staining was visualized using a selective fluorescent filter block. The merged images (FIGS. 9D, 9H, 9I) were obtained by superimposing the single-stained images as described in Example 1.

[0041]FIG. 10. Molecular model of cell surface binding of fVIII/vWf complex and subsequent catabolism of fVIII. Initial binding of fVIII/vWf complex occurs mainly via an interaction with HSPGs, followed by LRP-mediated endocytosis occurring via clathrin-coated pits (Chen, W. J., et al., J. Biol. Chem. 265:3116-3123 (1990)) and LRP-independent endocytosis which is directly mediated by HSPGs. Since vWf does not follow fVIII in the endocytic pathway in the cell culture experiments (Saenko, E. L., et al., J. Biol. Chem. 274:37685-37692 (1999)), it apparently dissociates from fVIII prior to entry of the complex into endosomal compartments.

[0042]FIG. 11. Domain structure of fVIII and its fragments. The domain structure of mature fVIII protein is shown in line 1. The LCh acidic region is labeled as AR. Thrombin-cleaved LCh (A3-C1-C2), heterotrimeric fVIIIa (A1/A2/3-C1-C2) and heterodimer A1/A3-C1-C2 are shown in lines 2, 3 and 4.

[0043]FIGS. 12A-12B. The amino acid sequence of mature, B-domainless fVIII (SEQ ID NO:5; composed from GenBank Accession No. X01179). The A2 sequence within fVIII is underlined and the sequence of the LRP binding site (residues 484-509) within A2 is indicated with asterisks. The amino acid residues are shown as one-letter amino acid abbreviations.

[0044]FIGS. 13A-13B. The deduced amino acid sequence of full-length factor VIII (SEQ ID NO:2; from GenPep Accession No. CAA25619.1 and GenBank Accession No. X01179).

[0045]FIG. 14. The deduced amino acid sequence of RAP (SEQ ID NO:4; GenBank Accession No. M63959). The signal sequence (amino acids 1-34) is underlined and the LDL receptor binding region (amino acids 237-353) is indicated with asterisks.

[0046]FIGS. 15A-15B. Binding of ¹²⁵I-fVIII to purified LRP by ligand competition assay. ¹²⁵I-fVIII (1 nM) was incubated for 1 h at 37° C. in wells coated with LRP (•) or BSA (∘) in the presence of increasing concentrations of unlabeled competitors, fVIII (•, ∘) or vWf (Δ) (FIG. 15A) and RAP (•, ∘) (FIG. 15B). In the experiment (Δ), ¹²⁵I-fVIII was preincubated with vWf for 30 min at 37° C., prior to its addition to the wells. Following incubation, the wells were washed and ¹²⁵I-fVIII binding was determined. Binding of ¹²⁵I-fVIII in the presence of unlabeled fVIII, vWf, or RAP is expressed as the percentage of ¹²⁵fVIII binding, when no competitor was added. Each point represents the mean value of triplicates and the error bars display the standard deviation. The curves show a best fit of the data to a model describing heterologous ligand displacement from a single class of binding sites using the program LIGAND.

[0047]FIG. 16. Effect of fragments of fVIII on its binding to LRP. ¹²⁵fVIII (1 nM) and increasing concentrations of unlabeled HCh (•), A2 (▴), LCh (∘) or A1/A3-C1-C2 (Δ) were incubated with LRP as described in FIG. 15. Each point represents the mean value and the standard deviation of the triplicates. The data were fitted as in FIGS. 15A-15B to a model describing heterologous ligand displacement from a single class of binding sites with K_(i) values of 120 and 132 nM for HCh and A2, respectively.

[0048]FIGS. 17A-17B. Effect of monoclonal antibodies and synthetic peptides on ¹²⁵fVIII binding to purified LRP. (FIG. 17A) ¹²⁵fVIII (1 nM) and increasing concentrations of mAbs 413 (•) or T5 (∘) were added to LRP coated wells as described in FIGS. 15A-15B. In the control experiment (Δ), ¹²⁵If-VIII and increasing concentrations of mAb 413 were added to BSA coated wells. (FIG. 17B) ¹²⁵I-fVIII and increasing concentrations of synthetic peptides consisting of the A2 domain residues 484-509 (•) or 432-456 (∘) were added to LRP coated wells. In the control experiment (Δ), ¹²⁵I-fVIII and increasing concentrations of the peptide 484-509 were added to BSA coated wells. Binding of ¹²⁵I-fVIII in the presence antibodies or peptides is expressed as the percentage of its binding, when no competitor was added. The mean and standard deviation of the triplicate measurements are presented.

[0049]FIGS. 18A-18B. Internalization and degradation of ¹²⁵I-fVIII/vWf complex by LRP-expressing (MEF) and LRP-deficient (PEA 13) fibroblasts. Wells containing 2×10 of each MEF (∘, •) or PEA 13 cells (Δ, ▴) were incubated with 1 nM ¹²⁵I-fVIII/vWf in the absence (closed symbols) or presence (opened symbols) of RAP (1 μM). ¹²⁵I-fVIII/vWf complex was prepared by incubation of ¹²⁵I-fVIII with unlabeled vWf at a molar ratio 1:50 for 30 min at 37° C. At the indicated times, the amounts of internalized ¹²⁵I-fVIII (FIG. 18A) and degraded ¹²⁵I-fVIII (FIG. 18B) by the MEF and PEA 13 fibroblasts were determined as described under Experimental Procedures. In the experiment (∇), degradation of ¹²⁵I-fVIII (1 nM) by MEF cells in the presence of (0.1 mM) chloroquine is shown. Each data point represents the mean and standard deviation of duplicate determinations.

[0050]FIGS. 19A-19B. Comparison of internalization of isolated ¹²⁵I-fVIII and components of fVIII/vWf complex. Wells containing 2×10⁵ of each MEF and PEA 13 cells were incubated with 1 nM of isolated ¹²⁵I-fVIII or 1 nM of fVIII/vWf complex formed by mixing either ¹²⁵I-fVIII (1 nM) with unlabeled vWf (50 nM) or ¹²⁵I-vWf (50 nM) with unlabeled fVIII (1 nM). Following incubation for 6 hours with MEF cells in the absence of RAP (open bars) or in the presence of 1 μM RAP (solid bars) or after incubation with PEA 13 cells (hatched bars) the amounts of internalized (FIG. 19A) and degraded (FIG. 19B) isolated ¹²⁵I-fVIII, and ¹²⁵I-fVIII or ¹²⁵I-vWf from the fVIII/vWf complex were determined as described in FIGS. 18A-18B. The data shown are an average of duplicate determinations±standard deviation.

[0051]FIGS. 20A-20B. The A2 domain of fVIII inhibits the internalization and degradation of ¹²⁵I-fVIII/vWf complex by MEF fibroblasts. One nM of ¹²⁵I-fVIII/vWf complex was prepared as in FIGS. 18A-18B and incubated with 2×10⁵ of MEF cells in presence of 1 μM of A2 (∘), 1 μM of A1/A3-C1-C2 (Δ), or in the absence of any competitor (•). At the indicated times, the amounts of internalized (FIG. 20A) and degraded ¹²⁵I-fVIII (FIG. 20B) were determined as in FIGS. 18A-18B. Each data point represents the mean and standard deviation of duplicate determinations.

[0052] FIGS. 21A-D. Internalization and degradation of ¹²⁵I-A2 by MEF fibroblasts and by LRP-expressing smooth muscle cells (SMC) and alveolar epithelial cells (T2). In FIGS. 21A-21B, 2×10⁵ of MEF (∘, •) or PEA 13 cells (Δ, ▴) were incubated with 10 nM ¹²⁵I-A2 in the absence (closed symbols) or presence (opened symbols) of RAP (1 μM). At the indicated times, the amounts of internalized ¹²⁵I-A2 (FIG. 21A) and degraded ¹²⁵I-A2 (FIG. 21B) by the MEF and PEA 13 fibroblasts were determined as described in FIGS. 18A-18B. In the experiment (∇), degradation of ¹²⁵I-A2 by MEF cells in the presence (0.1 mM) chloroquine is shown. Each datapoint represents the mean and standard deviation of duplicate determinations. In FIGS. 21C-21D, ¹²⁵I-A2 (10 nM) was incubated for 4 h at 37° C. in the wells containing 3×10⁵ SMC (solid bars) or T2 (open bars) cells in the presence or absence of RAP (1 mM). The amount of ¹²⁵I-A2 internalized (FIG. 21C) and degraded (FIG. 21D) by the cells was determined as in FIGS. 18A-18B. The data shown are an average of duplicate determinations±standard deviation.

[0053]FIGS. 22A-22B. The effect of RAP on clearance of ¹²⁵I-A2 (A) or ¹²⁵I-fVIII/vWf (B) from plasma of mice. BALB/c mice were injected into the tail vein by sample containing ¹²⁵I-A2 (36 nM) (FIG. 22A) or ¹²⁵I-fVIII/vWf (20 nM) (FIG. 22B) in the absence (•) or presence (◯) of RAP (267 μM). At indicated time points, blood (50 μl) was collected into 10 μl of 100 mM EDTA and an aliquot (50 μl) was counted for radioactivity. The percentage of ligand remaining in circulation was calculated considering radioactivity of the aliquot taken at 1 min after injection as 100%. The clearance of each preparation was examined in two mice, and the data plotted represent the average value±standard deviation.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0054] “Factor VIII” (or “coagulation factor VIII”), as used herein, refers to a plasma glycoprotein that is a member of the intrinsic coagulation pathway and is essential to blood coagulation. A congenital X-linked deficiency of biologically active factor VIII results in Hemophilia A, a potentially life-threatening disorder. Unless otherwise specified or indicated, as used herein, “factor VIII” denotes any functional human factor VIII protein molecule in its normal role in coagulation, including any fragment, analog derivative or modified factor VIII. The human factor VIII cDNA nucleotide and full-length predicted amino acid sequences are shown in SEQ ID NOs:1 and 2, respectively. Human factor VIII peptides of the invention include full-length factor VIII, full-length factor VIII minus Met at the N-terminus, mature factor VIII (minus the signal sequence), mature factor VIII with an additional Met at the N-terminus, and/or factor VIII with or without a B domain. Factor VIII of the invention may also include porcine factor VIII. The cDNA and predicted amino acid sequences of the porcine factor VIII are disclosed in U.S. Pat. No. 5,859,204.

[0055] “Subunits” of factor VIII, as used herein, are the heavy and light chains of the protein. The heavy chain of factor VIII contains three domains, A1, A2, and B. The light chain of factor VIII also contains three domains, A3, C1, and C2. Factor VIII is synthesized as an approximately 300 kDa single chain protein with internal sequence homology that defines the “domain” sequence NH₂-A1-A2-B-A3-C1-C2-COOH.

[0056] In a factor VIII molecule, a “domain”, as used herein, is a continuous sequence of amino acids that is defined by internal amino acid sequence identity and sites of proteolytic cleavage by thrombin. Unless otherwise specified, factor VIII domains include the following amino acid residues: A1, residues Ala1-Arg372; A2, residues Ser373-Arg740; B, residues Ser741-Arg1648; A3, residues Ser1690-Ile2032; C1, residues Arg2033-Asn2172; C2, residues Ser2173-Tyr2332. The A3-C1-C2 sequence includes residues Ser1690-Tyr2332. The remaining sequence, residues Glu1649-Arg1689, is usually referred to as the factor VIII light chain activation peptide.

[0057] A “B-domainless” factor VIII or “B (−)” factor VIII, or fragment of thereof, as used herein, refers to any one of the factor VIII mutants described herein that lacks the B domain. The amino acid sequence of mature, B (−) factor VIII as constructed from GenBank Accession No. X0179 is shown in FIGS. 12A-12B (SEQ ID NO:5). B (−) factor VIII of the invention includes B (−) factor VIII with or without a signal sequence and with or without a Met at the N-terminus.

[0058] As used herein, a “mutant factor VIII or fragment thereof” or “factor VIII mutant or fragment thereof” is an active factor VIII molecule or fragment thereof comprising at least one amino acid substitution.

[0059] “RAP,” as used herein, refers to the receptor associated protein, also called the α₂ macroglobulin receptor-associated protein. RAP reduces receptor-dependent clearance of factor VIII. The human RAP deduced amino acid sequence is shown in FIG. 14 (SEQ ID NO:4; GenBank Accession No. P30533). The RAP cDNA sequence is shown in SEQ ID NO:3 and GenBank Accession. No. M63959. Mutant RAP proteins of the invention may have an amino acid substitution at one, two, three, four, five, six, seven, eight, nine, ten, eleven, twelve, thirteen, fourteen, fifteen, sixteen, seventeen, eighteen, nineteen, twenty or more positions of RAP. An amino acid substitution at “position” 327, for example, of RAP, refers to an amino acid substitution at amino acid 327 of the RAP amino acid sequence in GenBank Accession No. P30533.

[0060] By “amino acid substitution” is meant a substitution of one amino acid for one of the remaining 19 naturally occurring amino acids. By an amino acid substitution at any one of positions “484 to 509, ” for example, is meant an amino acid substitution any position in the range, including at positions 484 and 509. The mutant factor VIII or RAP proteins of the invention may have an amino acid substitution at one, two, three, four, five, six, seven, eight, nine, ten, eleven, twelve, thirteen, fourteen, fifteen, sixteen, seventeen, eighteen, nineteen, twenty or more positions.

[0061] An amino acid substitution at “position” 499, for example, of factor VIII, refers to an amino acid substitution at position 499 according to the numbering system of Wood et al., Nature 312:330-337 (1984).

[0062] “Half-life,” as used herein, refers to the half-life of factor VIII in circulation, as determined in animals such as mice, for example, using the method of Examples 1-3. Factor VIII has a half-life of 12-14 hours. As provided herein, methods to increase the half-life of factor VIII would lead to a factor VIII half-life of longer than 12-14 hours.

[0063] “Receptor-dependent clearance,” as used herein, refers to the receptor-mediated removal of factor VIII from circulation. As described in the examples, receptor-dependant clearance is exhibited by MEF cells and is inhibited by RAP. Receptor-dependent clearance includes, but is not limited to, LRP-mediated clearance of factor VIII. Additional receptors may be involved in receptor-dependent clearance. The terms receptor-“dependent” and receptor-“mediated” are used interchangeably herein.

[0064] “Receptor-independent clearance,” as used herein, refers to the removal of factor VIII from circulation by means other than receptor-dependent clearance. RAP does not inhibit receptor-independent clearance.

[0065] “Heparan sulfate proteoglycan (HSPG)-dependent clearance,” as used herein, refers to the removal of factor VIII from circulation by means of cell surface heparan sulfate proteoglycans (HSPGs). HSPG-dependent clearance is inhibited by heparin, heparinase, and protamine. HSPG-dependent clearance includes both receptor-dependent and receptor-independent clearance. “HSPG-dependent, receptor-independent clearance” is exhibited by LRP-deficient cells such as PEA 13 cells, and is inhibited by heparin, heparinase, or protamine but is not significantly inhibited by RAP. The terms HSPG-“dependent” and HSPG-“mediated” are used interchangeably herein. “HSPG” and “HSPGs” are used interchangeably herein.

[0066] “Factor VIII deficiency,” as used herein, includes deficiency in clotting activity caused by production of defective factor VIII, by inadequate or no production of factor VIII, or by partial or total inhibition of factor VIII by inhibitors. Hemophilia A is a type of factor VIII deficiency resulting from a defect in an X-linked gene and the absence or deficiency of the factor VIII protein it encodes. A deficiency in vWf can also cause phenotypic hemophilia A because vWf is an essential component of functional factor VIII. In these cases, the half-life of factor VIII is decreased to such an extent that it can no longer perform its particular functions in blood-clotting.

[0067] “Plasma,” as used herein, refers to the fluid, noncellular portion of the blood of humans or animals as found prior to coagulation. It is distinguished from serum, which is obtained after coagulation.

[0068] “Pharmaceutically acceptable carrier,” as used herein, refers to a non-toxic solid, semisolid or liquid filler, diluent, encapsulating material or formulation auxiliary of any type.

[0069] “Patient,” as used herein, refers to human or animal individuals receiving medical care and/or treatment.

[0070] “Congenital deficiency,” as used herein, refers to the condition of an individual that lacks, as a result of heredity, a compound found in normal individuals. Congenital deficiencies are permanent absent transplantation or genetic intervention, which at this time are not guaranteed cures.

[0071] “Acquired deficiency,” as used herein, refers to the condition of an individual that lacks, as a result of a non-congenital influence, a compound found in normal individuals. Acquired deficiencies are frequently the transient result of other conditions or their treatment, but are nonetheless debilitating and life threatening.

[0072] A “fusion protein,” as used herein, is the product of a gene in which the coding sequence for one protein is extensively altered, for example, by fusing part of it to the coding sequence for a second protein from a different gene to produce a gene that encodes the fusion protein. As used herein, a fusion protein is a subset of the factor VIII protein or RAP protein described in this application.

[0073] A “corresponding” nucleic acid or amino acid or corresponding sequence of either, as used herein, is one present at a site in a factor VIII or mutant factor VIII molecule or fragment thereof that has the same structure and/or function as a site in the factor VIII molecule of another species, although the nucleic acid or amino acid number may not be identical.

[0074] “Procoagulant activity,” as used herein, refers to factor VIII coagulation activity exhibited in a human factor VIII assay.

[0075] “Specific activity,” as used herein, refers to the activity that will correct the coagulation defect of human factor VIII deficient plasma. Specific activity is measured in units of clotting activity per milligram total factor VIII protein in a standard assay in which the clotting time of human factor VIII deficient plasma is compared to that of normal human plasma. One unit of factor VIII activity is the activity present in one milliliter of normal human plasma. In the assay, the shorter the time for clot formation, the greater the activity of the factor VIII being assayed. Mutant factor VIII has coagulation activity in a human factor VIII assay. This activity may be less than, equal to, or greater than that of either plasma-derived or recombinant human factor VIII.

[0076] “Polypeptides,” “molecules” and “proteins,” as used herein, includes all polypeptides as described below. The basic structure of polypeptides is well known and has been described in innumerable textbooks and other publications in the art. In this context, the term is used herein to refer to any peptide or protein comprising two or more amino acids joined to each other in a linear chain by peptide bonds. As used herein, the term refers to both short chains, which also commonly are referred to in the art as peptides, oligopeptides and oligomers, for example, and to longer chains, which generally are referred to in the art as proteins, of which there are many types.

[0077] It will be appreciated that polypeptides often contain amino acids other than the 20 amino acids commonly referred to as the 20 naturally occurring amino acids, and that many amino acids, including the terminal amino acids, may be modified in a given polypeptide, either by natural processes, such as processing and other post-translational modifications, but also by chemical modification techniques which are well known to the art. Even the common modifications that occur naturally in polypeptides are too numerous to list exhaustively here, but they are well described in basic texts and in more detailed monographs, as well as in a voluminous research literature, and they are well known to those of skill in the art. Among the known modifications which may be present in polypeptides of the present invention are, to name an illustrative few, acetylation, acylation, ADP-ribosylation, amidation, PEGylation, covalent attachment off lavin, covalent attachment of a heme moiety, covalent attachment of a nucleotide or nucleotide derivative, covalent attachment of a lipid or lipid derivative, covalent attachment of phosphotidylinositol, cross-linking, cyclization, disulfide bond formation, demethylation, formation of covalent cross-links, formation of cystine, formation of pyroglutamate, formulation, gamma-carboxylation, glycosylation, GPI anchor formation, hydroxylation, iodination, methylation, myristoylation, oxidation, proteolytic processing, phosphorylation, prenylation, racemization, selenoylation, sulfation, transfer-RNA mediated addition of amino acids to proteins such as arginylation, and ubiquitination.

[0078] Such modifications are well known to those of skill and have been described in great detail in the scientific literature. Several particularly common modifications, glycosylation, lipid attachment, sulfation, gamma-carboxylation of glutamic acid residues, hydroxylation and ADP-ribosylation, for instance, are described in most basic texts, such as, for instance Proteins—Structure and Molecular Properties, 2nd Ed., T. E. Creighton, W.H. Freeman and Company, New York (1993). Many detailed reviews are available on this subject, such as, for example, those provided by Wold, F., Posttranslational Protein Modifications: Perspectives and Prospects, pp. 1-12 in Posttranslational Covalent Modification of Proteins, B. C. Johnson, Ed., Academic Press, New York (1983); Seifter et al., Analysis for protein modifications and nonprotein cofactors, Meth. Enzymol. 182:626-646 (1990) and Rattan et al., Protein Synthesis: Post translational Modifications and Aging, Ann. N.Y. Acad. Sci. 663: 48-62 (1992).

[0079] In general, as used herein, the term polypeptide encompasses all such modifications, particularly those that are present in polypeptides synthesized by expressing a polynucleotide in a host cell.

[0080] The invention also relates to fragments, “derivatives” and analogs of these polypeptides. The terms “fragment,” “derivative” and “analog” when referring to the polypeptides of FIGS. 12A-12B, 13A-13B or 14, means a polypeptide which retains essentially the same biological function or activity as such polypeptide. A mutant, fragment derivative or analog of factor VIII refers to a polypeptide that retains factor VIII procoagulant activity. A mutant, fragment derivative or analog of RAP refers to a polypeptide that retains the ability to reduce receptor-dependent clearance of factor VIII. Thus, an analog includes a proprotein which can be activated by cleavage of the proprotein portion to produce an active mature polypeptide. Fragments, derivatives and analogs are described in detail herein.

[0081] A fragment, derivative or analog of the polypeptide of the invention may be (i) one in which one or more of the amino acid residues includes a substituent group, or (ii) one in which the mature polypeptide is fused with another compound, such as a compound to increase the half-life of the polypeptide (for example, polyethylene glycol), or (iii) one in which the additional amino acids are fused to the mature polypeptide, such as a leader or secretory sequence or a sequence which is employed for purification of the mature polypeptide or a proprotein sequence. Such fragments, derivatives and analogs are deemed to be within the scope of those skilled in the art from the teachings herein.

[0082] The polypeptide of the present invention may be a recombinant polypeptide, a natural polypeptide or a synthetic polypeptide. In certain preferred embodiments it is a recombinant polypeptide.

[0083] Further particularly preferred in this regard are mutants, analogs and fragments; and mutants and analogs of the fragments, having the defined activity and/or having the amino acid sequence of the polypeptides of FIGS. 12A-12B, 13A-13B or 14.

[0084] The polypeptides and polynucleotides of the present invention are preferably provided in an isolated form, and preferably are purified to homogeneity.

[0085] “Polynucleotide(s)” generally refers to any polyribonucleotide or polydeoxribonucleotide, which may be unmodified RNA or DNA or modified RNA or DNA. Thus, for instance, polynucleotides as used herein refers to, among others, single- and double-stranded DNA, DNA that is a mixture of single- and double-stranded regions, single- and double-stranded RNA, and RNA that is mixture of single- and double-stranded regions, hybrid molecules comprising DNA and RNA that may be single-stranded or, more typically, double-stranded or a mixture of single- and double-stranded regions. In addition, polynucleotide as used herein refers to triple-stranded regions comprising RNA or DNA or both RNA and DNA. The strands in such regions may be from the same molecule or from different molecules. The regions may include all of one or more of the molecules, but more typically involve only a region of some of the molecules. One of the molecules of a triple-helical region often is an oligonucleotide.

[0086] As used herein, the term polynucleotide includes DNAs or RNAs as described above that contain one or more modified bases. Thus, DNAs or RNAs with backbones modified for stability or for other reasons are “polynucleotides” as that term is intended herein. Moreover, DNAs or RNAs comprising unusual bases, such as inosine, or modified bases, such as tritylated bases, to name just two examples, are polynucleotides as the term is used herein.

[0087] It will be appreciated that a great variety of modifications have been made to DNA and RNA that serve many useful purposes known to those of skill in the art. The term polynucleotide as it is employed herein embraces such chemically, enzymatically or metabolically modified forms of polynucleotides, as well as the chemical forms of DNA and RNA characteristic of viruses and cells, including simple and complex cells, inter alia.

[0088] Polynucleotides of the present invention may be in the form of RNA, such as mRNA, or in the form of DNA, including, for instance, cDNA and genomic DNA obtained by cloning or produced by chemical synthetic techniques or by a combination thereof. The DNA may be double-stranded or single-stranded. Single-stranded DNA may be the coding strand, also known as the sense strand, or it may be the non-coding strand, also referred to as the anti-sense strand.

[0089] Polynucleotides of the present invention may include, but are not limited to the coding sequence for the mature polypeptide, by itself; the coding sequence for the mature polypeptide and additional coding sequences, such as those encoding a leader or secretory sequence, such as a pre-, or pro- or prepro-protein sequence; the coding sequence of the mature polypeptide, with or without the aforementioned additional coding sequences, together with additional, non-coding sequences, including for example, but not limited to introns and non-coding 5′ and 3′ sequences, such as the transcribed, non-translated sequences that play a role in transcription, mRNA processing—including splicing and polyadenylation signals, for example—ribosome binding and stability of mRNA; additional coding sequence which codes for additional amino acids, such as those which provide additional functionalities. Thus, for instance, the polypeptide may be fused to a marker sequence, such as a peptide, which facilitates purification of the fused polypeptide. In certain preferred embodiments of this aspect of the invention, the marker sequence is a hexahistidine peptide, such as the tag provided in a pQE vector (Qiagen, Inc.), among others, many of which are commercially available. As described in Gentz et al., Proc. Natl. Acad. Sci., USA 86: 821-824 (1989), for instance, hexa-histidine provides for convenient purification of the fusion protein. The HA tag corresponds to an epitope derived of influenza hemagglutinin protein, which has been described by Wilson et al., Cell 37: 767 (1984), for instance.

[0090] An “effective amount” of an agent, as used herein, is an amount of such agent that is sufficient to bring about a desired result, especially upon administration of such agent to an animal or human.

[0091] The term “administration” is meant to include introduction of polypeptides or polynucleotides of the invention into an animal or human by any appropriate means known to the medical art, including, but not limited to, injection, oral, enteral, transdermal and parenteral (e.g., intravenous) administration.

[0092] The term “pharmaceutically acceptable salt” is intended to include salts of the mutant factor VIII or RAP of the invention. Such salts can be formed from pharmaceutically acceptable acids or bases, such as, for example, acids such as sulfuric, hydrochloric, nitric, phosphoric, etc., or bases such as alkali or alkaline earth metal hydroxides, ammonium hydroxides, alkyl ammonium hydroxides, etc.

[0093] The term “pharmaceutically acceptable composition” is intended to include solvents, carriers, diluents, and the like, which are utilized as additives or vehicles to preparations of the mutant factor VIII or RAP of the invention so as to provide a carrier or adjuvant for the administration of such compounds to patients (human or animal) in need of the same. Such additives can perform certain functions, such as, for example, provide the proper ionic conditions for administration, stabilize the mutant factor VIII or RAP against inactivation or degradation, and/or increase the half-life of the mutant factor VIII or RAP. A pharmaceutically acceptable composition is medically compatible with the host to which it is being administered.

[0094] The term “treatment” or “treating” is intended to include the administration of the pharmaceutically acceptable compositions of the invention comprising effective amounts of mutant factor VIII or RAP (polypeptides or polynucleotides) of the invention to a patient for purposes which may include prophylaxis, amelioration, prevention or cure of a medical disorder.

[0095] A material is said to be “substantially free of natural contaminants” if it has been substantially purified from materials with which it is normally and naturally found before such purification and those contaminants normally and naturally found with the substance in vivo or in vitro are substantially absent from the final preparation of the material. When administered to a subject in need of treatment, the mutant factor VIII or RAP of the invention is substantially free of natural contaminants which associate with the mutant factor VIII or RAP either in vivo (in the host from which the mutant factor VIII or RAP was isolated), or in vitro (as a result of a chemical synthesis). By “substantially absent” is meant that such contaminants are either completely absent or are present at such low concentrations that their presence (1) does not interfere with the desired therapeutic effect of the active agent in the therapeutically acceptable composition when such composition is administered to a patient in need of same and (2) does not harm the patient as the result of the administration of such composition.

[0096] Since current information indicates that the B domain has no known effect on factor VIII function, in some embodiments the B domain is deleted (“B domain (−)” or “B domainless”) in the mutant factor VIII molecule or fragments thereof (“B(−) factor VIII” or “B domainless factor VIII”) prepared by any of the methods described herein.

[0097] Generation of mutant(s) with a prolonged lifetime may be a promising approach to increase the efficacy and reduce the cost of fVIII infusion therapy. The invention provides methods of increasing the half-life of factor VIII by mutating factor VIII, and further provides methods of increasing the half-life of factor VIII using receptor-associated protein (RAP).

[0098] Factor VIII Mutants: A2 Domain

[0099] A recombinant mutant factor VIII having reduced receptor-dependent clearance and/or reduced receptor-independent clearance, and/or having superior coagulant activity, compared to human factor VIII, may be less expensive to make than plasma-derived factor VIII and may decrease the amount of factor VIII required for effective treatment of factor VIII deficiency.

[0100] The present invention provides active recombinant mutant factor VIII molecules or fragments thereof comprising at least one amino acid substitution in the A2 domain, polynucleotides encoding these, methods of producing and isolating them, and methods for characterizing their coagulant and plasma clearance properties.

[0101] The present inventors have discovered that factor VIII clearance from circulation is mediated by two pathways. One pathway—HSPGs-dependent, receptor-independent clearance—involves heparan sulfate proteoglycans (HSPGs). Another pathway—receptor-dependent clearance—involves HSPGs and low density lipoprotein receptor related protein (LRP). The present invention provides methods of increasing the half-life of factor VIII by reducing clearance via these pathways by substituting one or more amino acids in the A2 domain.

[0102] HSPG-Dependent, Receptor-Independent Clearance.

[0103] In one embodiment, the invention provides a method of increasing the half-life of factor VIII by substituting particular amino acids in the factor VIII A2 domain with nonconservative amino acids. In another embodiment, the invention provides mutant factor VIII and fragments thereof; and the polynucleotides encoding same, which have an increased circulating half-life over human factor VIII. The increased circulating half-life is due to a reduction in heparin sulfate proteoglycan (HSPG)-dependent, receptor-independent clearance of factor VIII. As shown in Example 1, particular amino acids in the factor VIII A2 domain interact with HSPGs in the HSPG-dependent clearance pathway. These amino acids are cationic residues in the A2 domain, as described below and in Example 1.

[0104] Factor VIII mutants of the invention include mutants with one or more nonconservative substitutions of cationic residues of the A2 domain. Thus, the factor VIII mutants of the invention include mutants with one or more substitutions within the A2 domain which replace basic (cationic)residues with non-basic (anionic) residues.

[0105] Thus, nonconservative A2 amino acid substitutions are preferred over conservative substitutions. Conservative amino acid substitutions include, for example, the substitution of an acidic amino acid with another acidic amino acid, a basic amino acid with another basic amino acid, a hydrophobic amino acid with a another hydrophobic amino acid, a polar amino acid with another polar amino acid, or an aromatic amino acid with another aromatic amino acid. Conservative amino acid substitutions are well known in the art.

[0106] Thus, an example of a conservative substitution is the substitution of the cationic residue Lys with the cationic residue Arg, while examples of preferred nonconservative substitutions are the substitution of Lys with Asp, Glu, Tyr, Asn, Gln, Thr, Ser, Cys, Trp, Phe, Pro, Met, Val, Leu, Ile, Trp, Gly or Ala. Additional examples of preferred nonconservative substitutions are the substitution of Arg with Asp, Glu, Tyr, Asn, Gln, Thr, Ser, Cys, Trp, Phe, Pro, Met, Val, Leu, Ile, Trp, Gly or Ala.

[0107] Preferred nonconservative amino acid substitutions in domain A2 are the substitution of the cationic residues Lys or Arg with Ser or Glu. Further preferred nonconservative amino acid substitutions of the invention include the substitution of Lys or Arg with Leu, Ile or Val. Additional preferred nonconservative amino acid substitutions of the invention are the substitutions of Lys or Arg with Asp or Glu. Further preferred nonconservative amino acid substitutions of the invention are the substitution of Lys or Arg with Ala, Ser, Thr, Met or Gly.

[0108] In a preferred embodiment, the factor VIII mutants have a nonconservative amino acid substitution at one or more positions selected from Lys(380), Arg(490), Lys(512), Lys(523), Arg(527), Lys(556), Arg(562), Lys(570), Arg(571), and/or Lys(659). In a preferred embodiment, the nonconservative substitutions are at Lys(380), Arg(490), Lys(512), Lys(523), Arg(527), and/or Lys(659). In a preferred embodiment, the nonconservative substitutions are at Lys(380), Arg(490), Lys(512), Lys(523), Arg(527), Lys(556), Arg(562), Lys(570), and/or Lys(659). In another preferred embodiment, the nonconservative substitutions are at Lys(380), Arg(490), Lys(512), Lys(523), Arg(527), Lys(556), Arg(562), and/or Lys(659). In another preferred embodiment, the nonconservative substitutions are at Lys(380), Arg(490), Lys(512), Lys(523), Arg(527), Lys(556), and/or Lys(659). Any combination of these cationic residues may be nonconservatively substituted.

[0109] In another preferred embodiment, the nonconservative substitution is at Arg(490) and at one or more of the positions above. Any combination of these cationic residues may be nonconservatively substituted.

[0110] In a preferred embodiment, the invention includes nonconservative substitutions at cationic residues in or near positions 558-565 which reduce HSPG-dependent, receptor-independent clearance. Such residues include Lys(556), Arg(562), Lys(570), and/or Arg(571). Additional residues near this region include Lys(523) and Arg(527). Any combination of these cationic residues may be nonconservatively substituted.

[0111] In a preferred embodiment, these nonconservative substitutions also reduce receptor-dependent clearance, such as LRP-dependent clearance.

[0112] Receptor-Dependent Clearance.

[0113] In one embodiment, the invention provides a method of increasing the half-life of factor VIII by substituting amino acids in the factor VIII A2 domain. In another embodiment, the invention provides mutant factor VIII and fragments thereof, and the polynucleotides encoding same, which have an increased circulating half-life over human factor VIII. In this embodiment, the increased circulating half-life is due to a reduction in receptor-dependent clearance of factor VIII. As shown in Examples 3-4, amino acids in the factor VIII A2 domain interact with at least one receptor that mediates A2 clearance and factor VIII clearance from plasma.

[0114] Thus, factor VIII mutants of the invention include mutants with one or more substitutions within the A2 domain. In a preferred embodiment, the factor VIII mutants have an amino acid substitution at one or more positions from 484 to 509. This region includes the following sequence: NH₂— Arg Pro Leu Tyr Ser Arg Arg Leu Pro Lys Gly Val Lys His Leu Lys Asp Phe Pro Ile Leu Pro Gly Glu Ile Phe —COOH.

[0115] In another preferred embodiment, the factor VIII mutants have an amino acid substitution at one or more of positions 484, 489, 490, 493, 496 or 499.

[0116] The amino acid at a particular position is substituted with any of the 19 other naturally occurring amino acids. A2 amino acid substitutions of the invention are those that inhibit the interaction of factor VIII with its clearance receptor(s). Thus, nonconservative A2 amino acid substitutions arc preferred over conservative substitutions. Conservative amino acid substitutions include, for example, the substitution of an acidic amino acid with another acidic amino acid, a basic amino acid with another basic amino acid, a hydrophobic amino acid with a another hydrophobic amino acid, a polar amino acid with another polar amino acid, or an aromatic amino acid with another aromatic amino acid. Conservative amino acid substitutions are well known in the art.

[0117] Thus, an example of a conservative substitution is the substitution of Lys with Arg, while an example of a preferred nonconservative substitution is the substitution of Lys with Asp, Glu, Tyr, Asn, Gln, Thr, Ser, Cys, Trp, Phe, Pro, Met, Val, Leu, Ile, Trp, Gly or Ala.

[0118] Preferred A2 amino acid substitutions of the invention are the substitution of Lys or Arg with Leu, Ile or Val. Additional preferred A2 amino acid substitutions of the invention are the substitutions of Lys or Arg with Asp or Glu. Further preferred amino acid substitutions of the invention are the substitution of Lys or Arg with Ala, Ser, Thr, Met or Gly.

[0119] In another embodiment, amino acids at positions outside 484-509 are substituted, such as at positions 480, 481, 482, 483, 510, 511, 512 or 513. Preferred substitutions at these positions are those that reduce receptor-dependent clearance of factor VIII, such as introducing bully or negatively charged amino acids.

[0120] Factor VIII Proteins and Polynucleotides

[0121] Specifically provided as an exemplary and a preferred embodiment is active recombinant human factor VIII having substituted amino acids in the A2 domain, polynucleotides encoding it, and methods of producing, isolating, and characterizing its activity. The methods by which this mutant is prepared can also be used to prepare active recombinant factor VIII or fragments thereof having substituted amino acids in domains other than A2. One skilled in the art will recognize that these methods also demonstrate how other recombinant mutant factor VIII molecules or fragments thereof can be prepared in which amino acids are substituted. Additionally, recombinant methods are described in Current Protocols in Molecular Biology, F. M. Ausubel et al., eds. (1991); and Sambrook, J., et al., Molecular Cloning. A Laboratory Manual.

[0122] Mutant factor VIII is prepared starting with human cDNA (Biogen, Inc.) encoding the factor VIII sequence. In a preferred embodiment, the factor VIII encoded by this cDNA includes domains A1-A2-A3-C1-C2, lacking the entire B domain, and corresponds to amino acid residues 1-740 and 1649-2332 of single chain human factor VIII (see SEQ ID NO:2), according to the numbering system of Wood et al., 312 Nature 330-337 (1984).

[0123] The mutant factor VIII cDNA are cloned into expression vectors for ultimate expression of active factor VIII protein molecules in cultured cells by established techniques, as described by Selden, R. F., “Introduction of DNA into mammalian cells,” in Current Protocols in Molecular Biology, F. M. Ausubel et al., Ids (1991).

[0124] In a preferred embodiment, a cDNA encoding mutant factor VIII is inserted in a mammalian expression vector, such as ReNeo, to form a mutant factor VIII construct. Preliminary characterization of the mutant factor VIII is accomplished by insertion of the mutant cDNA into the mammalian expression vector and transient expression of the mutant protein in COS-7 cells. A determination of whether active protein is expressed can then be made. The expression vector construct is used farther to stably transfect cells in culture, such as baby hamster kidney cells, using methods that are routine in the art, such as liposome-mediated transfection (Lipofectin™, Life Technologies, Inc.). Expression of recombinant mutant factor VIII protein can be confirmed, for example, by sequencing, Northern and Western blotting, or polymerase chain reaction (PCR). Mutant factor VIII protein in the culture media in which the transfected cells stably expressing the protein are maintained can be precipitated, pelleted, washed, and resuspended in an appropriate buffer, and the recombinant mutant factor VIII protein purified by standard techniques, including immunaffinity chromatography using, for example, monoclonal anti-A2-Sepharose™.

[0125] In a further embodiment, the mutant factor VIII comprising amino acid substitution(s) is expressed as a fusion protein from a recombinant molecule in which a sequence encoding a protein or peptide that enhances, for example, stability, secretion, detection, isolation, or the like is inserted in place adjacent to the factor VIII coding sequence. Established protocols for use of homologous or heterologous species expression control sequences including, for example, promoters, operators, and regulators, in the preparation of fusion proteins are known and routinely used in the art. (See Current Protocols in Molecular Biology, Ausubel, F. M., et al., Ids, Wiley Interscience, N.Y.)

[0126] Other vectors, including both plasmid and eukaryotic viral vectors, may be used to express a recombinant gene construct in eukaryotic cells depending on the preference and judgment of the skilled practitioner (see, for example, Sambrook et al., Chapter 16). Other vectors and expression systems, including bacterial, yeast, and insect cell systems, can be used but are not preferred due to differences in, or lack of, glycosylation.

[0127] The purified mutant factor VIII or fragment thereof can be assayed for amount and for coagulation activity by standard assays including, for example, the plasma-free factor VIII assay, the one-stage clotting assay, and the enzyme-linked immunosorbent assay using purified recombinant human factor VIII as a standard.

[0128] Recombinant mutant factor VIII protein can be expressed in a variety of cells commonly used for culture and recombinant mammalian protein expression. A preferred cell line, available from the American Type Culture Collection, Manassas, Va., is baby hamster kidney cells, which are cultured using routine procedure and media.

[0129] Any mutant factor VIII construct having an amino acid substitution at one or more positions in the A2 domain as described can be assayed by standard procedures for coagulant activity and may be assayed as described herein to identify mutant factor VIII molecules with enhanced coagulant activity and/or reduced receptor-mediated clearance and/or reduced HSPG-dependent clearance. Mutant molecules may also be identified that have reduced coagulant activity compared to human or porcine factor VIII but also have reduced receptor-mediated clearance or reduced HSPG-dependent clearance. One skilled in the art will recognize that mutant factor VIII molecules or fragments thereof having less, equal, or greater coagulant activity, compared to human or porcine factor VIII, are useful for treating patients who have a factor VIII deficiency. The methods described herein to prepare active recombinant mutant factor VIII with amino acid substitution(s) in the A2 domain can be used to prepare active recombinant mutant factor VIII protein with amino acid substitution(s) in the C2 domain or fragments thereof.

[0130] These molecules can be expressed in COS-7 cells and baby hamster kidney cells as described above. They can be purified to homogeneity using methods known in the art, such as heparin-Sepharose™ and immunoaffinity chromatography. Protein concentration can be estimated by absorption of ultraviolet light at A₂₈₀, and the specific activity of the constructs can be determined by dividing coagulant activity (measured in units per ml by single stage clotting assay) by A₂₈₀. Human factor VIII has a specific activity of approximately 3000-4000 U/A₂₈₀, whereas porcine factor VIII has a specific activity of approximately 20,000 U/A₂₈₀. In a preferred embodiment, the coagulant mutant factor VIII has a specific activity of 3000 U/A₂₈₀. In a preferred embodiment, the coagulant mutant factor VIII has a specific activity of 3000 U/A₂₈₀. The a specific activity of mutant factor VIII may be anywhere in the range of 1000-20,000 U/A₂₈₀.

[0131] As described herein, site-directed mutagenesis techniques are used to identify mutant protein with coagulant activity that can be enhanced, equal to, or reduced, compared to human factor VIII, but preferably is enhanced. Oligonucleotide-directed mutagenesis can be used as described in Kunkel, T. A., et al., Meth. Enzymol. 204:125-139 (1991).

[0132] The mutant factor VIII proteins of the invention may have an amino acid substitution at one, two, three, four, five, six, seven, eight, nine, ten, eleven, twelve, thirteen, fourteen, fifteen, sixteen, seventeen, eighteen, nineteen, twenty or more positions of factor VIII. The mutant factor VIII molecules of the invention may have amino acid substitutions in more than one domain, such as having an amino acid substitution both in the A2 domain and in the C2 domain.

[0133] The present invention contemplates that mutant factor VIII cDNA and protein can be characterized by methods that are established and routine, such as DNA sequencing, coagulant activity assays, mass by ELISA and by UV absorbency at 280 nm of purified mutant factor VIII, specific coagulant activity (U/mg), SDS-PAGE of purified mutant factor VIII, and the like. Other known methods of testing for clinical effectiveness may be required, such as amino acid, carbohydrate, sulfate, or metal ion analysis.

[0134] Factor VIII Mutants: C2 Domain

[0135] The same methods employed for preparing mutant human factor VIII having A2 domain amino acid substitution(s) can be used to prepare other recombinant mutant factor VIII protein and fragments thereof and the polynucleotides encoding these, such as mutant factor VIII having amino acid substitutions in the C2 domain.

[0136] Mutant human factor VIII molecules with amino acid substitution(s) in the C2 domain, which have reduced or no receptor-independent clearance can be identified. More specifically, the procedures can be the same or similar to those described herein for amino acid substitution in the A2 domain (by alanine scanning mutagenesis, site-directed mutagenesis, etc.,) substituting amino acids in the C2 domain of B (−) factor VIII; insertion into an expression vector, such as pBluescript; expression in cultured cells; and routine assay for coagulant activity and receptor-independent clearance.

[0137] In one embodiment, the invention provides mutant factor VIII and fragments thereof, and the polynucleotides encoding same, which have an increased circulating half-life over human factor VIII. The increased circulating half-life of mutant factor VIII is due to a reduction in receptor-independent clearance of factor VIII.

[0138] The C2 domain consists of amino acid residues 2173-2332. Within this 154 amino acid region, positions 2303-2332 are involved in both phospholipid binding and vWf binding. A synthetic peptide of factor VIII amino acids 2310-2320 (in which residues 2310 and 2320 are covalently linked) competes with factor VIII for phospholipid binding. A comparison of factor V, which does not bind vWf, and factor VIII reveals 5 amino acids within positions 2311-2319 that are unique to factor VIII. Although not being bound by any theory, these unique positions (Gln2311, Ser2312, Val2314, His2315 and Gln2316) are important for receptor-independent clearance, but are not critical for vWf binding.

[0139] Thus, one embodiment of the present invention is a mutant factor VIII having an amino acid substitution at one or more of positions 2173-2332 in the C2 domain. In another preferred embodiment, the mutant factor VIII has an amino acid substitution at one or more positions 2311-2319 in the C2 domain.

[0140] The amino acid at a particular position is substituted with any of the 19 other naturally occurring amino acids. C2 amino acid substitutions of the invention are those that inhibit the interaction of factor VIII with phospholipid. Thus, nonconservative C2 amino acid substitutions are preferred over conservative substitutions. Conservative amino acid substitutions include, for example, the substitution of an acidic amino acid with another acidic amino acid, a basic amino acid with another basic amino acid, a hydrophobic amino acid with a another hydrophobic amino acid, a polar amino acid with another polar amino acid, or an aromatic amino acid with another aromatic amino acid. Conservative amino acid substitutions are well known in the art.

[0141] Thus, an example of a conservative substitution is the substitution of Leu with Ile or Val, while an example of a preferred nonconservative substitution is the substitution of Leu with Asp, Glu, Arg, Lys, His, Tyr, Asn, Gln, Thr, Ser, Cys, Trp, Phe, Pro, Met, Trp, Gly or Ala. One preferred substitution is Ala.

[0142] Additional embodiments of the present invention include a method of treating hemophilia by administering a C2 domain mutant of factor VIII, pharmaceutically acceptable compositions comprising a C2 domain mutant of factor VIII either alone or in combination with RAP, and polynucleotides encoding a C2 domain mutant of factor VIII.

[0143] Furthermore, the amino acid substitution(s) in the C2 domain can be combined with amino acid substitution(s) in the A2 domain, to produce a mutant factor VIII with increased half-life.

[0144] Receptor Associated Protein (RAP)

[0145] A preferred embodiment of the present invention is directed to a method of increasing the half-life of factor VIII by administering RAP. Preferably, the RAP binds LRP, more preferably, the RAP has an increased affinity for LRP as compared to the naturally occurring RAP.

[0146] In another preferred embodiment of the present invention, RAP is a fragment, mutant or analog. Preferably, the RAP fragment, mutant or analog retains LRP binding activity. More preferably, the RAP fragment, mutant or analog has increased affinity for LRP as compared to the naturally occurring RAP.

[0147] In one embodiment, the RAP is a fragment having LRP binding activity. Such RAP fragments may comprise 10, 20, 30, 40, 50, 60, 75, 100, 125, 150, 175, 200, 250, 300 or 350 or more contiguous amino acids.

[0148] In one embodiment, RAP comprises amino acids 1 to 357 of FIG. 14 (full-length RAP; amino acids −19 to 323 of SEQ ID NO:4). RAP contains a signal sequence 34 amino acids in length. Thus, in another embodiment, RAP comprises amino acids 35 to 357 of FIG. 4 (mature RAP; amino acids 1 to 323 of SEQ ID NO:4).

[0149] In another embodiment of the present invention, RAP contains an N-terminal or a C-terminal deletion, or a combination of N- and C-terminal deletions. N-terminal deletions often result in a protein with increased stability. Thus, for example, deleting between 1 and 50 amino acids from the N-terminus of mature RAP is useful to produce a more stable RAP. Therefore, additional embodiments of the present invention include, for example, RAP comprising amino acids 36-357, 37-357, 38-357, 39-357, 40-357, 41-357, 42-357, 43-357, 44-357, 45-357, 46-357, 47-357, 48-357, 49-357, 50-357, 51-357, 52-357, 53-357, 54-357, 55-357, 56-357, 57-357, 58-357, 59-357, 60-357, 61-357, 62-357, 63-357, 64-357, 65-357, 66-357, 67-357, 68-357, 69-357, 70-357, 71-357, 72-357, 73-357, 74-357, 75-357, 76-357, 77-357, 78-357, 79-357, 80-357, 81-357, 82-357, 83-357, 84-357 and 85-357 of FIG. 14 (positions 1-323, 2-323, 3-323, 4-323, 5-323, 6-323, 7-323, 8-323, 9-323, 10-323, 11-323, 12-323, 13-323, 14-323, 15-323, 16-323, 17-323, 18-323, 19-323, 20-323, 21-323, 22-323, 23-323, 24-323, 25-323, 26-323, 27-323, 28-323, 29-323, 30-323, 31-323, 32-323, 33-323, 34-323, 35-323, 36-323, 37-323, 38-323, 39-323, 40-323, 41-323, 42-323, 43-323, 44-323,45-323,46-323, 47-323, 48-323, 49-323 and 50-323 of SEQ ID NO:4).

[0150] The LDL receptor binding domain encompasses amino acids 237 to 353 of FIG. 14 (amino acids 203 to 319 of SEQ ID NO:4). Thus, a preferred embodiment of the present invention is RAP comprising amino acids 237 to 353 (amino acids 203 to 319 of SEQ ID NO:4).

[0151] Another embodiment of the present invention is a polynucleotide encoding RAP.

[0152] In another embodiment of the present invention, RAP or a polynucleotide encoding RAP is used to treat hemophilia either alone or in combination with a factor VIII mutant.

[0153] Additional embodiments of the present invention include pharmaceutically acceptable compositions comprising RAP alone or in combination with one or more factor VIII mutants.

[0154] Pharmaceutically Acceptable Compositions

[0155] Pharmaceutically acceptable compositions comprising mutant factor VIII and/or RAP, alone or in combination with appropriate pharmaceutical stabilization compounds, delivery vehicles, and/or carrier vehicles, are prepared according to known methods, as described in Remington 's Pharmaceutical Sciences by E. W. Martin.

[0156] In one preferred embodiment, the preferred carriers or delivery vehicles for intravenous infusion are physiological saline or phosphate buffered saline.

[0157] In another preferred embodiment, suitable stabilization compounds, delivery vehicles, and carrier vehicles include but are not limited to other human or animal proteins such as albumin.

[0158] Phospholipid vesicles or liposomal suspensions are also preferred as pharmaceutically acceptable carriers or delivery vehicles. These can be prepared according to methods known to those skilled in the art and can contain, for example, phosphatidylserine/phosphatidylcholine or other compositions of phospholipids or detergents that together impart a negative charge to the surface, since factor VIII binds to negatively charged phospholipid membranes. Liposomes may be prepared by dissolving appropriate lipid(s) (such as stearoyl phosphatidyl ethanolamine, stearoyl phosphatidyl choline, arachadoyl phosphatidyl choline, and cholesterol) in an inorganic solvent that is then evaporated, leaving behind a thin film of dried lipid on the surface of the container. An aqueous solution of the mutant factor VIII and/or RAP is then introduced into the container. The container in then swirled by hand to free lipid material from the sides of the container and to disperse lipid aggregates, thereby forming the liposomal suspension.

[0159] Mutant factor VIII and/or RAP can be combined with other suitable stabilization compounds, delivery vehicles, and/or carrier vehicles, including vitamin K dependent clotting factors, tissue factor, and von Willebrand factor (vWf) or a fragment of vWf that contains the factor VIII binding site, and polysaccharides such as sucrose.

[0160] Mutant factor VIII can be stored bound to vWf to increase the shelf-life of the mutant molecule. Additionally, lyophilization of factor VIII can improve the yield of active molecules in the presence of vWf. Lyophilization can also improve the yield of RAP. Current methods for storage of human and animal factor VIII used by commercial suppliers can be employed for storage of mutant factor VIII or RAP. These methods include: (1) lyophilization of factor VIII in a partially-purified state (as a factor VIII “concentrate” that is infused without further purification); (2) immunoaffinity-purification of factor VIII by the Zimmerman method and lyophilization in the presence of albumin, which stabilizes the factor VIII; (3) lyophilization of recombinant factor VIII in the presence of albumin.

[0161] Additionally, factor VIII has been indefinitely stable at 4° C. in 0.6 M NaCl, 20 mM MES, and 5 mM CaCl₂ at pH 6.0 and also can be stored frozen in these buffers and thawed with minimal loss of activity.

[0162] Methods of Treatment

[0163] Mutant factor VIII and/or RAP is used to treat uncontrolled bleeding due to factor VIII deficiency (e.g., intraarticular, intracranial, or gastrointestinal hemorrhage) in hemophiliacs with and without inhibitory antibodies and inpatients with acquired factor VIII deficiency due to the development of inhibitory antibodies. The active materials are preferably administered intravenously.

[0164] Factor VIII is classically defined as that substance present in normal blood plasma that corrects the clotting defect in plasma derived from individuals with hemophilia A. The coagulant activity in vitro of purified and partially-purified forms of factor VIII is used to calculate the dose of factor VIII for infusions in human patients and is are liable indicator of activity recovered from patient plasma and of correction of the in vivo bleeding defect. There are no reported discrepancies between standard assay of novel factor VIII molecules in vitro and their behavior in the dog infusion model or in human patients, according to Lusher, J. M., et al., New. Engl. J. Med. 328:453-459 (1993); Pittman, D. D., et al., Blood 79:389-397 (1992), and Brinkhous et al., Proc. Natl. Acad. Sci. 82:8752-8755 (1985).

[0165] Usually, the desired plasma factor VIII level to be achieved in the patient through administration of the mutant factor VIII is in the range of 30-100% of normal. In a preferred mode of administration of the mutant factor VIII, the composition is given intravenously at a preferred dosage in the range from about 5 to 50 units/kg body weight, more preferably in a range of 10-50 units/kg body weight, and most preferably at a dosage of 20-40 units/kg body weight; the interval frequency is in the range from about 8 to 24 hours (in severely affected hemophiliacs); and the duration of treatment in days is in the range from 1 to 10 days or until the bleeding episode is resolved. See, e.g., Roberts, H. R., and M. R. Jones, “Hemophilia and Related Conditions—Congenital Deficiencies of Prothrombin (Factor II, Factor V, and Factors VII to XII),” Ch. 153, 1453-1474, 1460, in Hematology, Williams, W. J., et al., ed. (1990).

[0166] Administration of an effective amount of RAP will result in similar levels of factor VIII in patient blood as indicated above. Patients with inhibitors may require more mutant factor VIII, or patients may require less mutant factor VIII because of its higher specific activity than human factor VIII or increased plasma half-life. Likewise, patients may require more or less RAP, depending on RAP's binding affinity to LRP or other factor VIII clearance receptor, or depending on its stability in circulating blood. As in treatment with human or porcine factor VIII, the amount of mutant factor VIII or RAP infused is defined by the one-stage, factor VIII coagulation assay and, in selected instances, in vivo recovery is determined by measuring the factor VIII in the patient's plasma after infusion. It is to be understood that for any particular subject, specific dosage regimens should be adjusted over time according to the individual need and the professional judgment of the person administering or supervising the administration of the compositions, and that the concentration ranges set forth herein are exemplary only and are not intended to limit the scope or practice of the claimed composition.

[0167] Administration

[0168] In a preferred embodiment, pharmaceutically acceptable compositions of mutant factor VIII or RAP alone or in combination with stabilizers, delivery vehicles, and/or carriers are infused into patients intravenously according to the same procedure that is used for infusion of human or animal factor VIII.

[0169] The treatment dosages of mutant factor VIII or RAP composition that must be administered to a patient in need of such treatment will vary depending on the severity of the factor VIII deficiency. Generally, dosage level is adjusted in frequency, duration, and units in keeping with the severity and duration of each patient's bleeding episode. Accordingly, the mutant factor VIII or RAP is included in the pharmaceutically acceptable carrier, delivery vehicle, or stabilizer in an amount sufficient to deliver to a patient a therapeutically effective amount of the mutant protein to stop bleeding, as measured by standard clotting assays.

[0170] Treatment can take the form of a single intravenous administration of the composition or periodic or continuous administration over an extended period of time, as required. Alternatively, mutant factor VIII or RAP can be administered subcutaneously or orally with liposomes in one or several doses at varying intervals of time. Mutant factor VIII or RAP can also be used to treat uncontrolled bleeding due to factor VIII deficiency in hemophiliacs who have developed antibodies to human factor VIII.

[0171] Suitable examples of sustained-release preparations include semipermeable matrices of solid hydrophobic polymers containing the protein, which matrices are in the form of shaped articles, e.g. films, or microcapsules. Examples of sustained-release matrices include polyesters, hydrogens, e.g., poly(2-hydroxyethyl-methacrylate) as described by Langer et al., J. Biomed. Mater. Res. 15:167-277 (1981) and Langer, Chem. Tech. 12: 98-105 (1982) or poly(vinylalcohol), polylactides (U.S. Pat. No. 3,773,919, EP 58,481), copolymers of L-glutamic acid and gamma ethyl-L-glutamate (Sidman et al., Biopolymers 22:547-556 (19831)), non-degradable ethylene-vinyl acetate (Langer et al., supra), degradable lactic acid-glycolic acid copolymers such as the Lupron Depot™ (injectable microspheres composed of lactic acid-glycolic acid copolymer and leuprolide acetate), and poly-D-(−)-3-hydroxybutyric acid (EP 133,988). While polymers such as ethylene-vinyl acetate and lactic acid-glycolic acid enable release of molecules for over 100 days, certain hydrogels release proteins for shorter time periods. When encapsulated proteins remain in the body for a long time, they may denature or aggregate as a result of exposure to moisture at 37° C., resulting in a loss of biological activity and possible changes in immunogenicity. Rational strategies can be devised for protein stabilization depending on the mechanism involved. For example, if the aggregation mechanism is discovered to be intermolecular S—S bond formation through thio-disulfide interchange, stabilization can be achieved by modifying sulfhydryl residues, lyophilizing from acidic solutions, controlling moisture content, using appropriate additives, and developing specific polymer matrix compositions.

[0172] Sustained-release blood factor compositions also include liposomally entrapped blood factor or antibody. Liposomes containing the claimed blood factor or antibody are prepared by methods known per se: DE 3,218,121; Epstein et al., Proc. Natl. Acad. Sci. USA, 82: 3688-3692 (1985); Hwang et al., Proc. Natl. Acad. Sci. USA, 77:4030-4034 (1980); EP 52,322; EP 36,676; EP 88,046; EP 143,949; EP 142,641; Japanese patent application 83-118008; U.S. Pat. No. 4,485,045 and 4,544,545; and EP 102,324. Ordinarily the liposomes are of the small (about 200-800 Angstroms) unilamelar type, the selected proportion being adjusted for the optimal blood factor therapy. Liposomes with enhanced circulation time are disclosed in U.S. Pat. No. 5,013,556. Additionally, Giles, A. R., et al. Brit. J. Hematol. 69:491-497 (1988) describe the formulation of factor Xa in phosphatidylcholine-phosphatidylserine vesicles.

[0173] Additionally, mutant factor VIII or RAP can be administered by transplant of cells genetically engineered to produce the protein or by implantation of a device containing such cells, as described below.

[0174] Gene Therapy

[0175] Polynucleotides encoding the mutant factor VIII or RAP may be employed in accordance with the present invention by expression of such mutant factor VIII or RAP in vivo, in treatment modalities often referred to as “gene therapy.”

[0176] Mutant factor VIII or RAP can also be delivered by gene therapy in the same way that human factor VIII can be delivered, using delivery means such as retroviral vectors. This method consists of incorporation of factor VIII cDNA into human cells that are transplanted directly into a factor VIII deficient patient or that are placed in an implantable device, permeable to the factor VIII molecules but impermeable to cells, that is then transplanted. The preferred method will be retroviral-mediated gene transfer. In this method, an exogenous gene (e.g., a factor VIII cDNA) is cloned into the genome of a modified retrovirus. The gene/cDNA is inserted into the genome of the host cell by viral machinery where it will be expressed by the cell. The retroviral vector is modified so that it will not produce virus, preventing viral infection of the host. The general principles for this type of therapy are known to those skilled in the art and have been reviewed in the literature (e.g., Kohn, D. B., and P. W. Kantoff, Transfusion 29:812-820 (1989)).

[0177] Thus, for example, cells from a patient may be engineered with a polynucleotide, such as a DNA or RNA, encoding a polypeptide ex vivo, and the engineered cells then can be provided to a patient to be treated with the polypeptide. For example, cells may be engineered ex vivo by the use of a retroviral plasmid vector containing RNA encoding a polypeptide of the present invention. Such methods are well-known in the art and their use in the present invention will be apparent from the teachings herein.

[0178] Similarly, cells may be engineered in vivo for expression of a polypeptide in vivo by procedures known in the art. For example, a polynucleotide of the invention may be engineered for expression in a replication defective retroviral vector, as discussed above. The retroviral expression construct then may be isolated and introduced into a packaging cell is transduced with a retroviral plasmid vector containing RNA encoding a polypeptide of the present invention such that the packaging cell now produces infectious viral particles containing the gene of interest. These producer cells may be administered to a patient for engineering cells in vivo and expression of the polypeptide in vivo. These and other methods for administering a polypeptide of the present invention by such method should be apparent to those skilled in the art from the teachings of the present invention.

[0179] Retroviruses from which the retroviral plasmid vectors herein above mentioned may be derived include, but are not limited to, Moloney Murine Leukemia Virus, spleen necrosis virus, retroviruses such as Rous Sarcoma Virus, Harvey Sarcoma Virus, avian leukosis virus, gibbon ape leukemia virus, human immunodeficiency virus, adenovirus, Myeloproliferative Sarcoma Virus, and mammary tumor virus. In one embodiment, the retroviral plasmid vector is derived from Moloney Murine Leukemia Virus.

[0180] Such vectors well include one or more promoters for expressing the polypeptide. Suitable promoters which may be employed include, but are not limited to, the retroviral LTR; the SV40 promoter; and the human cytomegalovirus (CMV) promoter described in Miller et al. Biotechniques 7: 980-990 (1989), or any other promoter (e.g., cellular promoters such as eukaryotic cellular promoters including, but not limited to, the histone, RNA polymerase III, and β-actin promoters). Other viral promoters which may be employed include, but are not limited to, adenovirus promoters, thymidine kinase (TK) promoters, and B19 parvovirus promoters. The selection of a suitable promoter will be apparent to those skilled in the art from the teachings contained herein.

[0181] The retroviral plasmid vector is employed to transduce packaging cell lines to form producer cell lines. Examples of packaging cells which may be transfected include, but are not limited to, the PE501, PA317, Y-2, Y-AM, PA12, T19-14X, VT-19-17-H2, YCRE, YCRIP, GP+E−86, GP+envAm12, and DAN cell lines as described in Miller, A., Human Gene Therapy 1:5-14 (1990). The vector maybe transduced into the packaging cells through any means known in the art. Such means include, but are not limited to, electroporation, the use of liposomes, and CaPO₄ precipitation. In one alternative, the retroviral plasmid vector may be encapsulated into a liposome, or coupled to a lipid, and then administered to a host.

[0182] The producer cell line will generate infectious retroviral vector particles, which include the polynucleotide(s) encoding the polypeptides. Such retroviral vector particles then may be employed to transduce eukaryotic cells, either in vitro or in vivo. The transduced eukaxyotic cells will express the polynucleotide(s) encoding the polypeptide. Eukaryotic cells which may be transduced include, but are not limited to, embryonic stem cells, embryonic carcinoma cells, as well as hematopoietic stem cells, hepatocytes, fibroblasts, myoblasts, keratinocytes, endothelial cells, and bronchial epithelial cells.

[0183] The following examples are illustrative only and are not intended to limit the scope of the invention as defined by the appended claims. It will be apparent to those skilled in the art that various modifications and variations can be made in the methods of the present invention without departing from the spirit and scope of the invention. Thus, it is intended that the present invention cover the modifications and variations of this invention provided they come within the scope of the appended claims and their equivalents.

[0184] All patents, publications and publicly available sequences referred to herein are expressly incorporated by reference.

EXAMPLES Example 1

[0185] We have shown that in a cell culture and in vivo fVIII is catabolized from its complex with vWf and this process is mediated by low-density lipoprotein receptor-related protein (LRP) (Examples 2-4; Saenko, E. L., et al., J. Biol. Chem. 274:37685-37692(1999)). LRP, a member of the low density lipoprotein (LDL) receptor family (Neels, J. G., et al., Fibrinol. Proteol. 12:219-240 (1998)), is responsible for plasma clearance of lipoprotein remnants, serine proteinases and their complexes with inhibitors (serpins) (Neels, J. G., et al., Fibrinol. Proteol. 12:219-240 (1998); Strickland, D. K., et al., FASEB J. 9:890-898 (1995)). LRP is prominent in liver on hepatocytes and in vasculature and is presented on the surface of smooth muscle cells, fibroblasts and macrophages, (Moestrup, S. K., et al., Cell Tissue Res. 269:375-382 (1992)). In addition to fVIII, LRP mediates the clearance of a number of proteins involved in blood coagulation and fibrinolysis, such as factors IXa (Lenting, P., et al., Blood 94:455a (1999)) and Xa (Narita M., et al., Blood 91:555-560(1998); Kamikubo, Y., et al., Thromb. Res. 83:161-173 (1996)), plasminogen activators and their complexes with plasminogen activator inhibitor (Warshawsky, I., et al., Proc. Natl. Acad. Sci. U.S.A. 91:6664-6668 (1994); Herz, J., et al., Cell 71:411-421 (1992); Orth, K., et al., J. Proc. Natl. Acad. Sci. USA. 89:7422-7426(1992)). The 39 kDa receptor-associated protein (RAP), which binds to LRP with high affinity (K_(d)=4 nM) and efficiently inhibits binding and endocytosis of all known LRP ligands, is a useful tool for studying interactions of LRP and its ligands (Williams, S. E., et al., J. Biol. Chem. 267:9035-9040 (1992)).

[0186] The sites of fVIII involved in interaction with LRP are located in A2 domain residues 484-509 (Saenko, E. L., et al., J. Biol. Chem. 274:37685-37692 (1999)) and in the C-terminal portion of the C2 domain (Lenting, P., et al., J. Biol. Chem. 274:23734-23739 (1999)). Since the latter region of fVIII is likely to be blocked by vWf molecule bound to the C2 domain (Lenting, P., et al., J. Biol. Chem. 274:23734-23739 (1999); Saenko, E. L., et al., J. Biol. Chem. 269:11601-11605 (1994)), the C2 site may contribute to the clearance of fVIII only in the absence of vWf. This is consistent with the reported faster clearance of fVIII in vWf deficient patients and animals (Lethagen, S., et al., Ann. Hematol. 65:253-259 (1992); Fijnvandraat, K., et al., Thromb. Haemost. 77:298-302 (1997); Over, J., et al., J. Clin. Invest. 62:223-234(1978)), which has been shown to be mediated by LRP (Shwarz, H. P., et al., Blood 95:1703-1708 (2000)).

[0187] For many proteins, LRP-mediated endocytosis is facilitated by cell-surface heparan sulfate proteoglycans (HSPGs), one of the components constituting the extracellular matrix. It is currently believed that one of the general functions of cell surface HSPGs is to provide initial binding of proteins to cells, thus increasing the rates at which the proteins interact with their specific receptors (Lander, A. D., Matrix Biology 17:465-472 (1998)). Among the ligands of LRP that bind the HSPGs are lipoprotein lipase (Chappell, D. A., et al., J. Biol. Chem. 268:14168-14175 (1993)), apoE-containing lipoproteins (Ji, Z. S., et al., J. Biol. Chem. 269:2764-2772 (1994); Mahley, R. W. and Ji, Z. S., J. Lipid. Res. 40:1-16 (1999)), thrombospondin (Mikhailenko, L., et al., J. Biol. Chem. 270:9543-9549 (1995)), thrombin-protease nexin 1 complex (Knauer, M. F., et al., J. Biol. Chem. 274:275-281 (1999)) and tissue factor pathway inhibitor (TFPI) (Warshawsky, I., et al., Proc. Natl. Acad. Sci. USA. 91:6664-6668 (1994); Warshawsky, I., et al., J. Biol. Chem. 271:25873-25879 (1996)). For some of these ligands, HSPGs serve as co-receptors of LRP and provide the initial cell surface binding and subsequent presentation to LRP (Strickland, D. K., et al., FASEB J. 9:890-898 (1995); Mahley, R. W. and Ji, Z. S., J. Lipid. Res. 40:1-16 (1999)). For other ligands, HSPGs function themselves as catabolic receptors acting independently of LRP (Mikaelsson, M., et al., Thromb. Haemost. 69:1210(1993)). Noteworthy, all LRP ligands that interact with HSPGs are also able to bind heparin (Crisp, R. J., et al., J. Bio. Chem. 275:19628-19637 (2000)), which is structurally similar to carbohydrate portions of HSPG molecules.

[0188] The reported K_(d) for the fVIII interaction with LRP (116 nM (Saenko, E. L., et al., J. Biol. Chem. 274:37685-37692 (1999))) is much higher than the normal concentration of fVIII in plasma (˜1 nM (Wion, K., et al., Nature 317:726-730 (1985))), indicating that the direct binding of plasma fVIII/vWf complex to LRP is negligible and that other receptors may be involved in this process. In this example, we studied the participation of cell surface HSPGs in the binding and catabolism of fVIII/vWf complex, based on the ability of fVIII to interact with heparin (Barrow, R. T., et al., J. Biol. Chem. 269:593-598 (1994)). We demonstrated that HSPGs are indeed responsible for the initial binding of fVIII/vWf complex to the surface of various LRP-expressing cells and facilitate fVIII catabolism both in cell culture and in vivo. We showed that the binding occurs via the fVIII moiety of the fVIII/vWf complex and we localized the major heparin-binding site of fVIII to its A2 domain.

[0189] Experimental Procedures

[0190] Reagents.

[0191] Heparin (average molecular weight 17-19 kDa) and biotinylated heparin were purchased from Sigma and Celsus Laboratories Inc., respectively. Human coagulation factors IXa, X and Xa Enzyme Research Laboratories) and heparinase I (Sigma) were obtained from the indicated vendors. Active site fluorescently-labeled factor IXa (F1-FFR-fIXa) was obtained from Dr. Philip Fay. Anti-A2 mAb 8860 was provided by Baxter/Hyland Healthcare Inc. The rabbit polyclonal anti-LRP antibody Rab 2629 was provided by Dr. Dudley Strickland. Phosphatidylserine (PS) and phosphatidylcholine (PC) were obtained from Sigma. Phospholipid vesicles containing 25% PS and 75% PC were prepared as previously described (Barenholz, Y., et al., Biochemistry 16:2806-2810 (1977)). The synthetic peptides were synthesized using a 9050 Milligen synthesizer (Millipore) by 9-fluorenmethoxycarbonyl method and pentafluoro ester activation chemistry and were purified by reverse phase HPLC using C18 column (Waters) in gradient of 0-70% acetonitrile in 0.1% trifluoroacetic acid. The 2.2-3.5 mM solutions of peptides were dialyzed versus 20 mM HEPES pH 7.4, 0.15 M NaCl (HBS) using membrane with 1 kDa cut-off (Pierce).

[0192] Proteins.

[0193] FVIII was purified from therapeutic concentrates prepared by Method M, American Red Cross (Saenko, E. L., et al, J. Biol. Chem. 271:27424-27431 (1996)). HCh and LCh of fVIII were prepared as described previously (Saenko, E. L. and Scandella, D., J. Biol. Chem. 272:18007-18014 (1997)). The A1 and A2 subunits were obtained from thrombin activated fVIII using ion exchange chromatography on Mono S column (Amersham Pharmacia Biotech) (Saenko, E. L., et al., J. Biol. Chem. 274:37685-37692 (1999)).

[0194] Radiolabeling of fVIII and its A2 Subunit.

[0195] Prior to labeling, fVIII and A2 were dialyzed into 0.2 M sodium acetate, pH 6.8, containing 5 mM calcium nitrate. Five μg of fVIII in 30 μl of the above buffer were added to lactoperoxidase beads (Worthington Biochemical Corp.) containing 5 μl of Na¹²⁵I (100 mCi/ml, Amersham Pharmacia Biotech) and 5 μl of 0.03% H₂O₂ (Mallincrodt) and incubated for 4 min at room temperature. Unreacted Na¹²⁵I was removed by chromatography on PD10 column (Amersham Pharmacia Biotech). The specific radioactivities of ¹²⁵I-labeled fVIII and A2 were 3-6 μCi/μg of protein. The activity of ¹²⁵I-fVIII determined in the one-stage clotting assay (Lollar, P., et al., Methods Enzymol. 222:128-143 (1993)) (3650 units/mg) was similar to that of unlabeled FVIII (3840 units/mg).

[0196] Assays for Cell Mediated Surface Binding, Internalization and Degradation of Ligands.

[0197] LRP-expressing mouse embryonic fibroblast cells (MEF) and mouse embryonic fibroblast cells genetically deficient in LRP biosynthesis (PEA 13) were obtained from Dr. Joachim Herz (University of Texas Southwestern Medical Center, Dallas, Tex.) and maintained as described (Willnow, T. E. and Herz, J., J. Cell Sci. 107:719-726 (1994)). Cells were grown to 2×10⁵ cells/well as previously described (Saenko, E. L., et al., J. Biol. Chem. 274:37685-37692 (1999)). Human smooth muscle cells (SMC) (ATCC Deposit No. CRL 1999) and alveolar epithelial cells (T2) (ATCC Deposit No. CRL 2078) were obtained from the American Tissue Culture Collection, 10801 University Boulevard, Manassas, Va. 20110-2209. SMC and T2 cells were gown to the final density of 10⁵ cells/well in DMEM and Leibovitz's L-15 mediums, respectively, containing 10% Fetal Bovine Serum (Gibco BRL). Complex of ¹²⁵I-fVIII or unlabeled fVIII with fVIII was prepared by incubation of the proteins at a 1:50 ratio in HBS, 5 mM CaCl₂ for 30 min at 25° C. The formation of the complex was verified by gel filtration as described previously (Saenko, E. L., et al., J. Biol. Chem. 274:37685-37692 (1999)).

[0198] To assess the contribution of HSPGs in fVIII uptake, the cells were pre-incubated with medium containing heparinase-I (Sigma) at a concentration of 0.005 IU/ml for 30 min at 37° C. followed by washing the cells three times with HBS, 0.1% BSA. Surface binding, internalization and degradation assays were conducted as described previously (Kounnas, M. Z., et al., J. Biol. Chem. 270:9307-9312 (1995)). In some experiments, surface binding was determined after incubation at 4° C. to prevent endocytosis (Knauer, M. F., et al., J. Biol. Chem. 272:29039-29045 (1997)). Surface binding of radiolabeled ligands was defined as the amount of radioactivity released by the treatment of the cells with trypsin (50 μg/ml) and proteinase K (50 μg/ml) (Sigma) as described (Chappell, D. A., et al., J. Biol. Chem. 267:25764-25767 (1992)). This treatment was previously shown to release radioligands bound to the cell surface (Kounnas, M. Z., et al., J. Biol. Chem. 270:9307-9312 (1995)), therefore radioactivity remaining associated with the cells was considered to be internalized. Degradation was defined as radioactivity in the medium that is soluble in 10% trichloroacetic acid. The value of degradation was corrected for non-cellular mediated degradation by subtracting the amount of degradation products in parallel wells lacking cells.

[0199] Factor Xa Generation Assay.

[0200] The rate of conversion of factor X to factor Xa was measured in a purified system (Lollar, P., et al., Methods Enzymol. 222:128-143 (1993)) in which fVIIIa was substituted by its A2 subunit as described (Fay, P. J., et al., J. Biol. Chem. 273:19049-19054(1998); Fay, P. J. and Scandella, D., J. Biol. Chem. 274:29826-29830 (1999)). A2 subunit (200 nM) was preincubated for 30 min with varying concentrations of heparin (0-100 μg/ml) in HBS, 5 mM CaCl₂, 0.01% Tween 20 and 200 μg/ml BSA. This was followed by the addition of factor IXa (5 nM) and phosphatidyl serine phosphatidyl choline (PSPC) vesicles (10 μM) for 10 min, prior to the addition of factor X (300 nM). To determine the initial rates of factor Xa generation, aliquots were removed at 10, 20, 30 and 45 min and the reaction was stopped with 0.05 M EDTA. Factor Xa generation was determined by conversion of synthetic substrate S-2765 (Chromogenix, Sweden) as described (Fay, P. J. and Scandella, D., J. Biol. Chem. 274:29826-29830 (1999)).

[0201] Fluorescence Anisotropy Measurements.

[0202] The measurements of interaction of fVIII A2 subunit and F1-FFR-fIXa were performed as described (Fay, P. J. and Scandella, D., J. Biol. Chem. 274:29826-29830 (1999)). Prior to the experiment, A2 was incubated with heparin at varying concentrations for 15 min at 25° C. in HBS, 5 mM CaCl₂. The anisotropy was measured in a 0.2 ml cell upon addition of PSPC vesicles (50 μM) and FI-FFR-fIXa (30 nM) in the presence or absence of factor X (400 nM). The measurements were carried out using SLM 8000C spectrofluorometer (SLM Instrument Inc.) at an excitation wavelength of 495 nm and an emission wavelength of 524 nm. The data were recorded 5 times for each reaction and averaged.

[0203] Kinetic Measurements Using Surface Plasmon Resonance (SPR).

[0204] The kinetics of interaction of fVIII and its fragments with heparin were measured by the surface plasmon resonance (SPR) technique using Biacore 3000 (Biacore, Sweden). Biotinylated heparin was immobilized at the level of ˜300 resonance units (RU) on the surface of a biosensor SA chip in HBS, 5 mM CaCl₂, 0.05% Tween 20. Binding of fVIII and its fragments was measured in the same buffer at a flow rate of 10 μl/min. Dissociation of the ligand was measured upon replacement of the ligand solution with buffer. The chip surface was regenerated by washing with 1 M NaCl, 0.05% Tween 20. The kinetic parameters were derived from kinetic curves using Biacore BIAevaluation 3.1 software.

[0205] Immunofluorescence Microscopy.

[0206] Human hepatocellular carcinoma cells HEP G2 (ATCC Deposit No. HB 8065) (American Tissue Culture Collection, 10801 University Boulevard, Manassas, Va. 20110-2209) were gown on coverslips to 80% confluence in DMEM containing 10% FBS at 37° C., 6% CO₂. Intact cells or cells treated with heparinase as above, were incubated with 10 nM of fVIII/vWf complex in 0.5 ml DMEM, 1% BSA for 2 h at 4° C. The cells were washed twice with phosphate-buffered saline (PBS), fixed in PBS containing 2% formaldehyde for 15 min at room temperature, and stained for fVIII, LRP and HSPGs by triple-label immunofluorescence staining.

[0207] Staining for fVIII was performed by sequential incubations with mouse anti-fVIII mAb 8860 (epitope within A2 subunit), biotinylated anti-mouse antibody and Texas Redconjugated Avidin D (2.5 μg/ml). Staining for LRP was performed by sequential incubations with rabbit polyclonal anti-LRP antibody Rab 2629, biotinylated anti-rabbit IgG and Fluorescein Avidin DCS (2.5 μg/ml). Staining for HSPGs was performed by sequential incubations with mouse monoclonal anti-heparan sulfate antibody 10E4 (Seikagaku Corporation), biotinylated anti-mouse IgG and AMCA Avidin D (5 μg/ml). The primary antibodies were added at 5 μg/ml and incubated with the cell samples for 1 h at 25° C. The secondary biotinylated antibodies and fluorescent reagents were purchased from Vector, Inc. and used according to the supplied protocols. Avidin/Biotin blocking kit (Vector) was applied after staining with each fluorescent probe. The specificity of the staining was determined in control experiments using normal mouse or rabbit immunoglobulins, instead of the primary antibodies.

[0208] For microscopy, the coverslips with triple-stained cells were mounted on slides with ProLong Antifade mounting medium (Molecular Probes, Inc.). The images were obtained using Eclipse E800 microscope (Nikon) equipped with a set of selective fluorescent filter blocks and digital SPOT RT camera (Diagnostic Instruments, Inc.). Simultaneous visualization of fVIII, LRP and HPGs was performed by merging the single-dye images using SPOT Advanced Program Mode.

[0209] Clearance of ¹²⁵I-fVIII/vWf Complex in Mice.

[0210] Prior to the experiment, ¹²⁵I-fVIII, vWf, and RAP were dialyzed in HBS, 5 mM CaCl₂ buffer. BALB/c mice (12-14 weeks old, weight 20-24 g)were injected in the tail vein with 100 μl of either 0.2 mM protamine or 150 μM RAP alone or with 100 μl of 0.2 mM protamine and 150 μM RAP together in the above buffer. After 2 min interval, 100 μl samples of ¹²⁵I-fVIII/vWf complex formed from ¹²⁵I-fVIII (15 nM) and vWf (750 nM) were injected into mice. In control experiment, ¹²⁵I-fVIII/vWf complex was injected in the absence of protamine and RAP. Blood samples of 35-40 μl were withdrawn from each mouse via retroorbital puncture into 15 μl of 0.1 M sodium citrate buffer, pH 7.4, at selected time intervals (1, 5, 10, 15, 30, 60, 120, 240, 360 and 480 min). The radioactivity of the samples was measured and normalized for the blood volumes withdrawn. The percentage of ¹²⁵I-fVIII remaining in circulation was calculated assuming the radioactivity of the aliquot taken at 1 min after injection as 100%. The time course of each of the above conditions was examined in four mice and averaged. The kinetics of ¹²⁵I-fVIII clearance from circulation was fitted using Sigmaplot 3.0 computer program (Jandel Scientific) to a previously used double-exponential model (Saenko, E. L., et al., J. Biol. Chem. 274:37685-37692 (1999)) as described in the text.

[0211] Results

[0212] HSPGs are the Primary Receptors Responsible for Initial Binding of fVHIII/vWf Complex to LRP-Expressing Cells.

[0213] We previously demonstrated that RAP inhibited endocytosis and degradation of fVIII from its complex with vWf by LRP-expressing cells, indicating that LRP is involved in the catabolism of fVIII (Saenko, E. L., et al., J. Biol. Chem. 274:37685-37692 (1999)). To elucidate whether LRP participates in the initial binding of ¹²⁵I-fVIII/vWf complex to the cell surface, we tested whether this binding is inhibited by RAP. As seen from FIG. 1A, the presence of RAP did not significantly reduce the surface binding of ¹²⁵I-fVIII/vWf complex, suggesting that the complex binds to the cell surface not via LRP, but via some other receptor(s). We next examined whether HSPGs are responsible for the initial binding of fVIII/vWf complex by testing the effect of heparin or heparinase, which are known to inhibit the interaction of HSPGs with their ligands. As seen from FIG. 1A, both agents significantly reduced the cell surface binding, indicating that HSPGs are the major surface receptors responsible for the initial binding of fVIII/vWf complex to cells. Consistent with a role for HSPGs in the surface binding of fVIII/vWf, degradation of fVIII was reduced by heparinase treatment of the cells almost to the same degree as by addition of RAP to untreated cells (FIG. 1B). Addition of RAP to heparinase-treated cells inhibited degradation by >95%, showing that LRP and HSPGs are synergistically involved in fVIII catabolism in this cell model.

[0214] Noteworthy, LRP-deficient PEA13 cells also degraded fVIII at ˜25% the level of LRP-expressing cells (FIG. 1B), indicating existence of an alternative pathway of fVIII catabolism that is not mediated by LRP. Since this pathway was significantly inhibited by heparin or heparinase (FIG. 1B), HSPGs are required not only for LRP-mediated, but also for an LRP-independent pathway of fVIII degradation.

[0215] The Major fVIII Site Involved in Binding to HSPGs is Located within its A2 Domain.

[0216] Since the fVIII site responsible for interaction with LRP is located within the A2 domain of fVIII (Saenko, E. L., et al., J. Biol. Chem. 274:37685-37692 (1999)), it is expected that LRP expressing cells will bind and catabolize isolated A2 domain. Indeed, we found that MEF cells bound and degraded isolated ¹²⁵I-A2 domain (FIGS. 1C and D). Noteworthy, surface binding of ¹²⁵I-A2 was inhibited by heparin and heparinase but not by RAP (FIG. 1C), showing that HSPGs are involved in the surface binding of A2, similar to that found for fVIII/vWf. In contrast to surface binding, degradation of ¹²⁵I-A2 in LRP-expressing cells was inhibited by RAP, consistent with the presence of a LRP-binding site within the A2 domain (Saenko, E. L., et al., J. Biol. Chem. 274:37685-37692 (1999)). Degradation of A2 was also inhibited by heparin or heparinase, and the combination of heparinase and RAP led to an almost complete suppression of degradation (FIG. 1D). Involvement of HSPGs in the catabolism of isolated A2 domain indicates that it contains an HSPGs-binding site.

[0217] To examine whether the involvement of HSPGs in LRP-mediated catabolism of A2 is a common feature of LRP-expressing cells, we tested the binding of A2 to human smooth muscle cells (SMC) and alveolar epithelial cells (T2) expressing LRP and HSPGs (Moestrup, S. K., et al., Cell Tissue Res. 269:375-382 (1992)). Both in the SMC and T2 cells heparin and heparinase significantly inhibited surface binding, internalization and degradation of ¹²⁵I-A2 (FIGS. 2A-2F). Addition of RAP to heparinase-treated cells had no effect on the ¹²⁵I-A2 binding, but led to a further decrease of the internalization and degradation. Thus, the effects of heparinase and RAP on A2 catabolism in MEF, SMC and T2 are similar, indicating that LRP and HSPGs are simultaneously involved in A2 catabolism by different LRP-expressing cells.

[0218] We next examined whether the A2 domain is fully responsible for the binding of fVIII/vWf complex to cell surface HSPGs. This was performed by studying the effect of a 200-fold molar excess of fVIII fragments and vWf on the surface binding of ¹²⁵I-fVIII/vWf complex to MEF and PEA13 cells. As seen from FIG. 3, A2 inhibited the binding of ¹²⁵I-fVIII/vWf complex to both cells types to the level observed for heparinase-treated cells. In contrast, neither A1/A3-C1-C2 heterodimer nor vWf were able to inhibit the binding of the ¹²⁵I-fVIII/vWf complex. This shows that fVIII but not vWf is responsible for the binding of fVIII/vWf complex to cell surface HSPGs and that the major HSPGs-binding site of fVIII is located within the A2 domain.

[0219] The A2 Domain and fVIII/vWf Complex Bind Cells with Similar Affinities.

[0220] The presence of the major HSPGs binding site within A2 implies that binding affinities of A2 and fVIII/vWf for the cells should be similar. To verify this, we first determined the binding affinity of ¹²⁵I-A2 to MEF cells in a saturation binding experiment. Nonspecific binding in the presence of a 100-fold excess unlabeled A2 was approximately 18% of total ¹²⁵I-A2 binding. The specific binding was adequately described by a model showing the existence of a single class of binding sites (9.6×10⁴ sites per cell) with K_(d) of 15±2.8 nM. In a control experiment, the ¹²⁵I-A2 binding curve obtained in the presence of RAP (1 μM) (data not shown) was identical to that obtained in the absence of RAP (FIG. 4A). To verify that A2 and fVIII/vWf complex bind to the same sites, we performed a displacement of ¹²⁵I-A2 (1 nM) by unlabeled A2 or fVIII/vWf. In this assay, A2 and fVIII/vWf were found to be equal competitors (FIG. 4B) with K_(i) values of 18.3±3.2 nM and 23.5±2.7 nM, respectively. The similarity of the K_(i) values further supports the conclusion that the binding of fVIII/vWf complex to HSPGs is mediated by the A2 domain of fVIII. Noteworthy, the binding properties of A2 were not altered by ¹²⁵I-labeling, since the K_(d) and K_(i) obtained for A2 using direct binding or homologous displacement are similar.

[0221] A Major Site within A2 and a Minor Site within LCh are Involved in fVIII Binding to Heparin.

[0222] To examine whether A2 is the only site responsible for fVIII interaction with HSPGs, we tested the binding of A2 and other fVIII fragments to heparin, used as a model molecule of carbohydrate portions of HSPGs. We found that fVIII, its A2 domain, HCh (containing A2), but not A1 were able to bind to heparin in a SPR-based assay (FIG. 5), consistent with the presence of the heparin-binding site within A2. Unexpectedly, LCh was also able to bind heparin, indicating that it contains another fVIII heparin-binding site. Consistent with this, fVIII kinetics was optimally fitted to a model showing the presence of two heparin binding sites (K_(d)s are 28 and 630 nM) within fVIII molecule. The kinetic parameters for fVIII and its fragments derived from the data in FIG. 5 are shown in Table 1. As seen from the Table, the site present in A2 (site 1) has a high affinity for heparin (K_(d)=28 nM), whereas the site present in LCh (site 2) has a low affinity (K_(d)=630 nM). The 20-fold lower affinity of the LCh site implies that its contribution to fVIII binding to heparin or HSPGs is not significant. Remarkably, the affinities of fVIII and A2 for heparin (Table 1) are similar to the affinities of fVIII/vWf complex and A2 for the cell surface HSPGs (18 and 23 nM, respectively). Altogether, these data further show that the major fVIII site responsible for binding to HSPGs is located within the A2 domain. TABLE 1 Kinetic parameters for binding of fVIII and its fragments to heparin. Ligand k_(on)(M⁻¹s⁻¹) k_(off)(s⁻¹) K_(d)(nM) fVIII  1.(1.4 ± 0.034) × 10⁴  (3.91 ± 0.4) × 10⁻⁴ 27.93 ± 2.94  2.(8.24 ± 0.12) × 10⁴  (5.38 ± 0.7) × 10⁻² 652.91 ± 12.68 HCh   (1.32 ± 0.038) × 10⁴  (3.1 ± 0.22) × 10⁻⁴ 23.48 ± 1.79 A2   (1.63 ± 0.053) × 10⁴  (4.2 ± 0.16) × 10⁻⁴ 25.77 ± 1.29 domain LCh   (7.84 ± 0.156) × 10⁴ (4.48 ± 0.06) × 10⁻²   571 ± 13.5

[0223] Table 1.

[0224] Association and dissociation of fVIII and its fragments to immobilized heparin were assessed in SPR-based experiment shown in FIG. 5. The kinetic data obtained for fVIII were optimally fitted using model of implying presence of two independent heparin-binding sites within the fVIII molecule. In the Table, these sites are referred to as 1 and 2. The kinetics of HCh, A2 and LCh interaction with heparin was optimized using a model assuming one heparin-binding site within each fragment. The association rate constants (k_(on)), dissociation rate constants (k_(off)) and affinities (Kd=k_(on)/k_(off)) were derived from the SPR data using Biacore software BIAevaluation 3.1.

[0225] The Region of the A2 Domain Delineated by Residues 558-565 is Involved in Binding to Heparin.

[0226] Localization of the A2 domain heparin-binding site was initiated by the previous findings that heparin inhibits Xase activity (Barrow, R. T., et al., J. Biol. Chem. 269:593-598 (1994); Barrow, R. T., et al., J. Biol. Chem. 269:26796-26800 (1994)) and fVIIIa can be substituted by A2 in the Xase assay (Fay, P. J. and Scandella, D., J. Biol. Chem. 274:29826-29830 (1999)). We found that heparin is also inhibitory in the A2-dependent Xase assay (FIG. 6A). The effect was dose-dependent and 90% inhibition was observed at 10 μg/ml (˜600 nM) of heparin.

[0227] Since it was previously shown that heparin does not inhibit interaction of the Xase complex with its substrate (factor X) (Barrow, R. T., et al., J. Biol. Chem. 269:26796-26800 (1994)), we proposed that heparin inhibits Xase assembly by preventing A2 binding to factor IXa. To examine this possibility, we tested the effect of heparin on A2 binding to factor IXa by the fluorescent anisotropy technique. The experiment was based on a previous observation that the anisotropy of active site modified FI-FFR-fIXa moderately increases upon binding of A2 (Fay, P. J. and Scandella, D., J. Biol. Chem. 274:29826-29830 (1999)) and this effect is more pronounced in the presence of factor X(Fay, P. J., et al., J. Biol. Chem. 273:19049-19054 (1998); Fay, P. J. and Scandella, D., J. Biol. Chem. 274:29826-29830 (1999)). We found that heparin inhibited the increase of anisotropy in a dose-dependent fashion, either in the absence or presence of factor Xa (FIG. 6B). The maximal effect of heparin was observed at ≧30 μg/ml, which is similar to that completely suppressing the factor Xase assay (FIG. 6A). In a control experiment performed in the absence of A2, heparin did not affect the anisotropy of FI-FFR-fIXa either in the absence and in presence of factor X.

[0228] The above findings show that heparin blocks the interaction between the A2 subunit and factor IXa, which might be due to an overlap of the A2 domain binding sites for heparin and for factor IXa. Since two regions within the A2 domain, 484-509 and 558-565, are known to be directly involved in the interaction with factor IXa (Fay, P. J. and Scandella, D., J. Biol. Chem. 274:29826-29830 (1999); Fay, P. J., et al, J. Biol. Chem. 269:20522-20527 (1994)), we tested the effects of these peptides on the binding of A2 to heparin. In a SPR-based experiment, the peptide 558-565 inhibited binding by 78% at 800 μM (FIG. 7A). In contrast, at the same concentration, the peptide 484-509 inhibited binding by approximately 25%, and the peptide 417-428 had no effect. This shows that the A2 domain region 558-565 is involved in the binding of fVIII to heparin and to cell surface HSPGs.

[0229] Cell Surface Proteoglycans Participate in fVIII Catabolism in Vivo.

[0230] To examine whether HSPGs contribute to fVIII clearance in vivo, fVIII clearance studies were performed in mice in the presence of protamine, which prevents HSPGs from interacting with their ligands (Warshawsky, L., et al., J. Biol. Chem. 271:25873-25879 (1996); Narita, M., et al., J. Biol. Chem. 270:24800-24804 (1995)). The data shown in FIG. 8 were fitted to the previously used double exponential model (Saenko, E. L., et al., J. Biol. Chem. 274:37685-37692(1999)), showing the existence of fast and slow phases of fVIII clearance. This model is described by the following equation:

C=C ₁ e ^(−k) ^(₁) ^(t) +C ₂ e ^(−k) ^(₂) ^(t)

[0231] where C is the percent of ¹²⁵I-fVIII remaining in plasma at a given time, k₁ and k₂ are the kinetic rate constants corresponding to the fast and slow phases of fVIII clearance, and C₁ and C₂ are percentages of administered radioactivity removed during the fast and slow phases of clearance, respectively. The values of k₁, k₂, C₁, and C₂ constants were derived for each clearance curve by fitting C versus t to the above equation. At a saturating concentration of RAP, the rate of the fast phase of clearance was dramatically reduced (Table 2), resulting in a prolongation of the half-life of fVIII by 3.5-fold, similar to that shown previously (Examples 2-3; Saenko, E. L., et al., J. Biol. Chem. 274:37685-37692 (1999)). Administration of protamine prolonged the fVIII half-life by 1.6-fold and reduced the rates of both phases of clearance (Table 2), which shows that HSPGs contribute to both RAP-sensitive and RAP-independent pathways of fVIII clearance. Noteworthy, co-injection of RAP and protamine resulted in a greater increase of the fVIII half-life (5.5-fold), than injection of RAP alone (3.5-fold). The above data demonstrate that HSPGs participate in fVIII clearance in vivo and are involved in the RAP-sensitive (most likely LRP-mediated) and RAP-independent catabolic pathways. TABLE 2 The effect of RAP and protamine on the parameters of fVIII clearance from plasma of mice. Added Agent C1(%) C2(%) K₁ (min⁻¹) K₂ (min⁻¹) None 58 ± 3.6 42 ± 3.7 0.0208 ± 0.0026 0.00345 ± 0.0009 RAP (150 μM) 7.4 ± 3.8  92.6 ± 6.2   0.00107 ± 0.0008  0.00367 ± 0.0012 protamine (0.2 mM) 63 ± 6.5 37 ± 7.6 0.0118 ± 0.0007 0.00225 ± 0.0004 RAP + protamine 12 ± 3.4 88 ± 6.5 0.0007 ± 0.0006 0.00232 ± 0.0006

[0232] Table 2.

[0233] The values of the kinetic rate constants k₁ and k₂, corresponding to the fast and slow phases of fVIII clearance and the percents of total radioactivity (C₁ and C₂, respectively) removed during these phases were determined by fitting clearance data shown in FIG. 7A as described in the Results Section.

[0234] FVIII is Co-Localized with HSPGs on the Surface of LRP-Expressing Hepatic Cells.

[0235] We previously found that injection of ¹²⁵I-fVIII/vWf complex into mice led to accumulation of most of the radioactivity in liver (Examples 2 and 3; Saenko, E. L., et al., J. Biol. Chem. 274:37685-37692 (1999)), where LRP is present in high abundance (Moestrup, S. K., et al., Cell Tissue Res. 269:375-382 (1992)). To elucidate whether HSPGs are involved in the initial fVIII binding to the liver cells, we performed direct visualization of fVIII, HSPGs and LRP in hepatic cells HEP G2, expressing both LRP and HSPGs (Butzow, R., et al., J. Cell. Biol. 122:721-727 (1993)). The cells were incubated with fVIII/vWf complex at 4° C. followed by triple-label immunofluorescent staining for fVIII, LRP and HSPGs (FIGS. 9A-9L). For each preparation, the distribution of fVIII, HSPGs or LRP is shown in red, blue and green images, respectively. For control cells, individual staining for fVIII, HSPGs and LRP are represented by the images in FIGS. 9A, 9B, and 9C, respectively. FVIII was distributed on the cell surface in a grainy pattern, typical for cell surface but not for cytoplasmic staining. The merged image in FIG. 9D demonstrates that fVIII co-localized predominantly with HSPGs as seen by the purple areas resulting from superimposing red and blue staining for fVIII and HSPGs, respectively. Co-localization of surface-bound fVIII with LRP was negligible, since large areas in the merged image remained green but not yellow, as would be expected for superimposed red and green images. Consistent with this, treatment of the cells by heparinase to remove glycosamine residues from HSPGs (FIG. 9F) led to a dramatic reduction of bound fVIII (FIG. 9E) and to a lack of purple areas on the merged image (FIG. 9H). In contrast, blocking of LRP by RAP (FIGS. 9I-9L) did not appreciably alter fVIII binding (FIG. 9I) compared to the control cells (FIG. 9A). In the merged image (FIG. 9L) fVIII remained colocalized with HSPGs, consistent with a negligible role of LRP in the initial surface binding of fVIII/vWf complex. Thus, the microscopy study confirms that HSPGs are the major receptors responsible for initial binding of fVIII/vWf complex to the surface of LRPexpressing cells.

[0236] Discussion

[0237] In the present study we found that cell surface HSPGs facilitate LRP-mediated catabolism of fVIII from its complex with vWf in cell culture and in vivo. In LRP-expressing cells, the bulk of initial binding of fVIII/vWf complex to the cells occurs via HSPGs, which cooperate with LRP receptor in the subsequent internalization of the fVIII molecule. In mice, the simultaneous blocking of HSPGs and LRP led to a significant prolongation of the fVIII half-life, compared to the fVIII half-life when HSPGs and LRP were individually blocked.

[0238] The interaction of fVIII/vWf complex with HSPGs occurs via the A2 domain of fVIII, based on observations that in LRP-expressing cells (i) the A2 subunit, but not other portions of fVIII or isolated vWf, strongly inhibited this binding; (ii) A2 subunit and fVIII/vWf complex bind to the cell surface with similar affinities; and (iii) A2 and fVIII have similar affinities for binding to heparin in a purified system. Although vWf was previously shown to interact with heparin, the apparent lack of its contribution to the binding is consistent with its weak affinity for heparin (K_(d) 2· μM, 78 μM (Poletti, L. F., et al., Arterioscler. Thromb. Vasc. Biol. 17:925-931 (1997); Maruch, D., et al., Thromb. Haemost. 71:141-146 (1994)), which is two to three orders of magnitude lower than the affinity determined in the present study for the fVIII and A2 interactions with heparin (˜28 nM). The A2 site involved in binding to heparin was localized to the region 558-565 based on the ability of the synthetic peptide encompassing this region to inhibit A2 binding to heparin. Noteworthy, the peptide 484-509, which corresponds to the previously localized LRP binding site (Examples 3-4; Saenko, E. L., et al., J. Biol. Chem. 274:37685-37692 (1999)), did not appreciably inhibit the binding, showing that the A2 domain sites responsible for binding to LRP and HSPGs are distinct.

[0239] Heparin-binding sites of proteins are commonly represented by cationic clusters formed by Arg and/or Lys, which interact with the anionic portion of the heparan-sulfate glycosaminoglycans molecule (Mann, D., et al., J. Biol. Chem. 269:23661-23667(1994)). Within the 558-565 region and in the close proximity to it, there are Lys⁵⁵⁶, Lys⁵⁶², Lys⁵⁷⁰ and Arg⁵⁷¹ exposed on the A2 surface according to the previously published 3D model of the A2 domain (Pemberton, S., et al., Blood 89:2413-2421 (1997)). Although we found another heparin binding site of fVIII within its LCh, this low affinity-binding site does not significantly contribute to interaction of fVIII with HSPGs, and in addition, may be blocked by vWf, which binds to LCh of fVIII (Saenko, E. L. and Scandella, D., J. Biol. Chem. 272:18007-18014 (1997)).

[0240] Cooperation of HSPGs with LRP in catabolizing fVIII is similar to their role in the catabolism of most heparin-binding LRP ligands (Warshawsky, I., et al., Proc. Natl. Acad. Sci. USA. 91:6664-6668 (1994); Chappell, D. A., et al., J. Biol. Chem. 268:14168-14175 (1993); Knauer, M. F., et al., J. Biol. Chem. 274:275-281 (1999); Kounnas, M. Z., et al., J. Biol. Chem. 270:9307-9312 (1995); Knauer, M. F., et al., J. Biol. Chem. 272:29039-29045 (1997); Mikhailenko, I., et al., J. Biol. Chem. 272:6784-6791 (1997)). The proposed role of HSPGs to in concentrating the ligands on the cell surface and in facilitating their subsequent internalization by presenting them to LRP (Strickland, D. K., et al., FASEB J. 9:890-898 (1995); Knauer, M. F., et al., J. Biol. Chem. 274:275-281 (1999)) is consistent with our data, since the affinity of fVIII/vWf complex for HSPGs and heparin (K_(d)=15-30 nM) is higher than that for LRP (K_(d)=116 nM (Saenko, E. L., et al., J. Biol. Chem. 274:37685-37692 (1999))).

[0241] The fact that in LRP-expressing cells, RAP effectively inhibited internalization and degradation of fVIII is consistent with our previous data that LRP is involved in the catabolism of fVIII (Saenko, E. L., et al., J. Biol. Chem. 274:37685-37692(1999)). At the same time, the finding that LRP-deficient cells were also able to internalize and degrade fVIII and that this process was strongly inhibited by heparinase, shows the existence of a LRP-independent pathway of fVIII catabolism that also is mediated by HSPGs. This is consistent with the biphasic clearance of fVIII in vivo, which reflects the existence of two different pathways of fVIII catabolism. According to our findings, both pathways involve HSPGs, as shown by the inhibition of both fast and slow phases of fVIII clearance by protamine. Since the fast phase of the fVIII clearance is also RAP-sensitive, we conclude that in this phase the fVIII/vWf complex binds to cell surface HSPGs, followed by endocytosis of fVIII that is mediated by LRP. The slow phase of fVIII clearance is LRP-independent but is also facilitated by HSPGS, similar to the LRP-independent pathway in cell culture. Noteworthy, simultaneous blocking of HSPGs and LRP by protamine and RAP, respectively, did not completely block the fVIII clearance in mice. The role of HSPGs based on the experiments in a cell model system and in vivo is depicted in FIG. 10, where catabolism of fVIII from its complex with vWf occurs via initial binding of the complex to HSPGs, followed by both the LRP-mediated and LRP-independent endocytosis and degradation of fVIII. The model indicates that vWf dissociates prior to fVIII internalization, since we had previously shown that vWf does not follow fVIII in the endocytic pathway (Saenko, E. L., et al., J. Biol. Chem. 274:37685-37692 (1999)).

[0242] The finding that isolated A2 domain of fVIII can be catabolized by HSPGs- and LRP-mediated mechanisms reflects the existence of specific pathways of clearance of activated fVIII. Heterotrimeric fVIIIa (A1/A2/A3-C1-C2) is an unstable molecule due to its rapid but reversible dissociation into the A2 and A1/A3-C1-C2 portions (Fay, P. J., et al., J. Biol. Chem. 266:8957-8962 (1991); Fay, P. J. and Smudzin, T. M., J. Biol. Chem. 267:13246-13250(1992)). Since the A2 subunit may reassemble with A1/A3-A3-C1 and restore fVIIIa activity and isolated A2 retains a weak fVIIIa-like ability to support Xase, clearance of the isolated A2 subunit has evolved as a mechanism for preventing formation of the Xase complex at inappropriate sites in the vasculature.

[0243] In summary, we demonstrated that fVIII catabolism from its complex with vWf involves initial binding of the complex to cell surface HSPGs, which is due to the interaction between polysaccharide portions of HSPGs and the heparin-binding site in the fVIII A2 domain. Upon binding of the fVIII/vWf complex to HSPGs, the fVIII molecule is catabolized via two pathways, LRP-mediated and LRP-independent. Finally, both HSPGs and LRP are involved in fVIII clearance in vivo, since simultaneous blocking of these receptors dramatically prolonged the half-life of fVIII in circulation.

Example 2

[0244] Activated factor VIII (fVIIIa) functions in the intrinsic pathway of blood coagulation as a cofactor for factor IXa in the conversion of factor X to activated factor X (Xa). When IXa is bound to membrane and fVIII the rate of factor X to IXa conversion increases 100,000-1,000,000 fold. The procoagulant activity of fVIIIa is regulated by rapid and potentially reversible dissociation of the A2 subunit from the A1/A3C1C2 dimer and by activated protein C (APC) proteolysis of the residual fVIIIa. Removal of the A2 and A1/A3C1C2 fragments is an additional in vivo mechanism to control factor VIIIa activity at the site of blood coagulation.

[0245] This was tested in a model system using mouse embryonic fibroblasts (MEF) that express low density lipoprotein receptor related protein (LRP) a multi ligand endocytic receptor and PEA 13 fibroblasts that are genetically deficient in LRP. Using the above model system the mechanisms of cellular uptake and degradation of thrombin activated fVIII subunits was studied to evaluate the roles of these mechanisms in regulating fVIIIa levels.

[0246] Methods

[0247] Cell Mediated Ligand Internalization and Degradation Assays.

[0248] Cells were seeded into 24 well dishes and allowed to grow for 24 hours at 37° C. 5% CO₂ MEF and PEA 13 cells were incubated for selected time intervals at 37° C. with ¹²⁵I-labeled fVIIIa fragments in the presence and absence of unlabeled competitors as described in the figure legends. Radioactivity appearing in the cell culture medium that was soluble after precipitation with 10% trichloroacetic acid (TCA) was taken to represent degraded ligand. Total ligand degradation was corrected by subtracting the amount of 10% TCA soluble radioactivity occurred in control wells lacking cells. The amount of labeled ligand bound to the cell surface or that was internalized by cells was determined as follows. Cells were washed with cold phosphate buffered saline and treated with a trypsin EDTA proteinase K solution. Surface bound material was defined as the amount of radioactive ligand released by this treatment and the amount of internalized ligand was defined as the amount of radioactivity which remained associated with the cell pellet following the treatment.

[0249] Determining of the A2 Affinity for LRP.

[0250] LRP (3.5 μg/ml) in 0.1 M NaHCO₃, pH 9.6 was incubated in Immulon I microtiter well strips for 16 hours at 4° C. After washing with TBS, 5 mM CaCl₂, 0.05% Tween 20 buffer(TBS-T) and blocking with 3% BSA, ¹²⁵I-A2 (5 nM and increasing concentrations unlabeled A2 (0-1750 nM) were added. Following the incubation for 1 hour at 37° C. and washing with TBS-T, the radioactivity bound to the wells was counted. ¹²⁵I-A2 binding in the presence of unlabeled A2 was plotted using the computer program “Ligand.” The K_(d) value for A2/LRP binding was calculated from the displacement curve, showing a best fit of the data to a single class of sites.

[0251] Effect of RAP on the Clearance of ¹²⁵I-A2 Domain from the Plasma of Mice.

[0252] To elucidate the role of LRP receptor in the clearance of the A2 domain from plasma in vivo we tested the plasma level of ¹²⁵I-labeled A2 in the presence and absence of RAP after tail vein injection in mice. 250 μl samples of A2 (36 nM), in the presence and absence of RAP (267 μM) were injected into the tail vein of BALB/c mice. At the indicated times, blood (50 μl) was collected into 10 μl of 0.5 M EDTA and counted for its ¹²⁵I content. RAP significantly delays the plasma elimination of A2 domain. This experiment indicates that a RAP dependent hepatic receptor, LRP, plays a major role in the removal of A2 from circulation.

[0253] LRP Receptor Mediated Internalization and Degradation of the ¹²⁵I-A2 Domain by Fibroblast Cells.

[0254] The cellular uptake and degradation of activated factor VIII fragments was studied using mouse embryonic fibroblast (MEF) cells expressing low density lipoprotein receptor-related protein (LRP), a multi ligand endocytic receptor, and PEA 13 cells represents fibroblasts lacking LRP. The fVIIIa subunit's interaction with MEF and PEA 13 cells represents an adequate model for in vivo processes because fibroblast cells became exposed to coagulation site upon vascular injury. LRP mediated internalization and degradation of some proteins (Thrombin:ATIII complex and other complexes of thrombin with inhibitors, tissue factor pathway inhibitor (TFPI)) involved in the coagulation cascade is known.

[0255]¹²⁵I-A2 (10 nM) was incubated with cells for the indicated times and the amount of surface bound, internalized and degraded ¹²⁵I-labeled protein were determined as described under “Methods.” The A2 domain was internalized and degraded by MEF cells but not by PEA 13 cells suggesting that expression of LRP receptor is required for these processes. The internalization and degradation of A2 was blocked by RAP, an inhibitor of LRP binding to its ligand.

[0256] Internalization of the ¹²⁵I-A2 and APC Cleaved A2 Domain, by LRP Presenting MEF Cells and Control PEA 13 Cells, Lacking LRP.

[0257] Inactivation of fVIIIa by APC leads to a cleavage of the A2 at Arg⁵⁶². Since cofactor activity cannot be reconstituted from A2_(N)/A2_(C) and A1/A3C1C2 dimer, we proposed that A2_(N)/A2_(C) removal from circulation may occur by a mechanism different from that for intact A2. To examine the effect of proteolysis by APC on cellular internalization of the A2 domain, we compared the ¹²⁵I-A2 and ¹²⁵I-A2_(N)/A2_(C) uptake by MEF and PEA 13 cells. We found that in contrast to A2 domain, the internalization of ¹²⁵I-A2_(N)/A2_(C) is not mediated by LRP receptor.

[0258] Binding the A2 Domain to the Immobilized LRP.

[0259] To the microtiter wells with immobilized LRP, ¹²⁵I-A2 (5 nM) and increasing concentrations of unlabeled A2 (0-1750 nM) were added. After incubation for 1 hour at 37° C., the wells were washed with TBS-T and radioactivity bound to the wells was counted. ¹²⁵I-A2 binding in the presence of unlabeled A2 is expressed as the percentage of ¹²⁵I-A2 binding, when no competitor was added. The data was analyzed using the computer program “Ligand”. The K_(d) value for A2/LRP binding calculated from the displacement data was 130 nM.

[0260] Internalization of ¹²⁵I-labeled A1/A3C1C2 and A1³³⁶/A3C1C2 by Fibroblast Cells.

[0261] We proposed that a phospholipid binding site previously localized to the C2 domain of fVIII light chain mediates the cellular surface binding and internalization of A1/A3C1C2 and A1³³⁶/A3C1C2 dimers. To test this hypothesis we determined internalization ¹²⁵I-A1/A3C1C2 and ¹²⁵I-A1³³⁶/A3C1C2 by MEF cells in the presence and absence of anti-C2 domain monoclonal antibody NMC-VIII/5, which blocks the membrane binding sites of the C2 domain.

[0262] Wells containing 2×10⁵ MEF cells were incubated with 3 nM of ¹²⁵I-A1/A3C1C2 or 3 nM of ¹²⁵I-A1³³⁶/A3C1C2 at 37° C. in the presence or absence of 30 nM monoclonal antibody NMC-VIII/5. In the control experiments, PEA 13 cells lacking LRP were incubated as above with ²⁵I-A1/A3C1C2 and ¹²⁵I-A1³³⁶/A3C1C2. At several times internalization of the dimers was measured as described under “Methods.”

[0263] Since internalization of both ¹²⁵I-A1/A3C1C2 and ¹²⁵I-A1³³⁶/A3C1C2 dimers was completely inhibited hy monoclonal antibody NMC-VIII/5, which recognizes the membrane binding site of fVIII C2 domain, we concluded that membrane binding of C2 is an important step required for internalization of the above dimers. The rate of internalization was similar for MEF and PEA 13 cells, which shows that LRP receptor is not involved in this process.

[0264] Degradation of ¹²⁵I-A1/A3C1C2 and ¹²⁵I-A1³³⁶/A3C1C2 by MEF Cells.

[0265] MEF cells were incubated with ¹²⁵I-A1/A3C1C2 (3 nM) or ¹²⁵IA1³³⁶/A3C1C2 (3 nM) for 22 hours at 37° C. in the presence and absence PAP (1 μM). The degradation of dimers was measured as described under “Methods”.

[0266] The degradation of A1/A3C1C2 dimer is RAP dependent. In contrast, degradation of APC cleaved A1³³⁶/A3C1C2 dimer is RAP independent and does not correlate with LRP expression.

[0267] Conclusions

[0268] The A2 domain was internalized and degraded by mouse embryonic fibroblasts (MEF) which are expressing low density lipoprotein receptor-related protein (LRP), a multi ligand endocytic receptor. The internalization and degradation of A2 was blocked by RAP, an inhibitor of LRP binding to its ligands. In vivo clearance studies in mice demonstrated that RAP inhibited the clearance of ¹²⁵I-A2 from circulation. The radioactivity was preferentially accumulated in liver in the absence but not in the presence of RAP. This indicates that a RAP sensitive hepatic receptor most likely LRP, plays a major role in the removal of ¹²⁵I-A2 from the circulation.

[0269] The phospholipid binding site previously localized to the C2 domain of fVIII light chain mediates the cellular membrane binding and internalization of A1/A3C1C2 and A1³³⁶/A3C1C2 dimers.

[0270] LRP receptor does not participate in cellular uptake and degradation of fragments A2_(N)/A2_(C) and A1³³⁶/A3C1C2, produced by irreversible inactivation of fVIIIa by APC. A2 and A1/A3C1C2 fragments produced by reversible inactivation of fVIIIa are removed by LRP-mediated and LRP-independent mechanisms, respectively. LRP is involved in the regulation of coagulation processes in vivo, by removal of A2 domain and A1/A3C1C2 dimer, the fragments from which active factor VIIIa can be reconstituted.

Example 3

[0271] The plasma glycoprotein factor VIII (fVIII) serves as a cofactor for the factor X activation complex in the intrinsic pathway of blood coagulation. FVIII circulates in plasma in a tight noncovalent complex with its carrier protein von Willebrand factor (vWf). Although the complex formation of fVIII with vWf is critical for maintenance of a normal half-life and level of fVIII in circulation, the mechanisms associated with fVIII turnover are not well defined. In the present study, we found that catabolism of fVIII is mediated by the low density lipoprotein receptor-related protein/α₂-macroglobulin receptor (LRP), a liver endocytic receptor responsible for in vivo clearance of a number of structurally unrelated ligands. A specific binding between fVIII and LRP was demonstrated by homologous ligand competition experiments, where a K_(d) of 116 nM was determined for fVIII binding to LRP. A 39 kDa receptor-associated protein (RAP), an antagonist of ligand binding by LRP, completely inhibited fVIII binding to purified LRP. The region of fVIII involved in its binding to LRP was localized to the A2 domain residues 484-509, based on the ability of the isolated A2 domain and the synthetic A2 domain peptide 484-509 to prevent fVIII interaction with LRP. Since vWf did not inhibit fVIII binding to LRP, we proposed that LRP receptor may internalize fVIII from its complex with vWf. In agreement with this, mouse embryonic fibroblasts (MEF) that express LRP, but not fibroblasts genetically deficient in LRP (PEA 13), were able to internalize and degrade ¹²⁵I-fVIII/vWf complex. The latter processes were competed by RAP and the A2 subunit of fVIII, indicating that cellular internalization and subsequent degradation were mediated by interaction of the A2 domain of fVIII with LRP. MEF cells were not able to internalize ¹²⁵I-vWf from ¹²⁵I-vWf/fVIII complex. This indicates that vWf does not follow fVIII in the LRP-mediated pathway and dissociates from fVIII at the early stage of endocytosis. In vivo clearance studies of ¹²⁵I-fVIII/vWf complex in mice demonstrated that RAP prolonged the half-life of ¹²⁵I-fVIII in circulation by 2.5-fold, indicating that a RAP-sensitive receptor, most likely LRP, is responsible for the plasma clearance of fVIII.

[0272] Introduction

[0273] The plasma glycoprotein factor VIII (fVIII) functions as a cofactor for the factor X activation enzyme complex in the intrinsic pathway of blood coagulation, and it is decreased or nonfunctional in patients with hemophilia A. The fVIII protein consists of a homologous A and C domains and a unique B domain which are arranged in the order A1-A2-B-A3-C1-C2 (Vehar, G. A., et al., Nature 312:337-340 (1984)). It is processed to a series of Me²⁺ linked heterodimers produced by cleavage at the B-A3 junction (Fay, P. J., et al., Biochem. Biophys. Acta. 871:268-278 (1986)), generating a light chain (LCh) consisting of an acidic region (AR) and A3, C1, and C2 domains and a heavy chain (HCh) which consists of the A1, A2, and B domains (FIG. 1).

[0274] Transplantational studies both in animals and in humans demonstrated that the liver hepatocytes are the major fVIII-producing cells (Lewis, J. H., et al., N. Engl. J. Med. 312:1189-1191 (1985); Bontempo, F. A., et al., Blood 69:1721-1724 (1987)). Immediately after release into circulation, fVIII binds with high affinity (K_(d)<0.5 nM (MacGregor, I. R., et al., Vox. Sang. 69:319-327 (1995); Saenko, E. L. and Scandella, D., J. Biol. Chem 272:18007-18014 (1995)) to its carrier protein vWf to form a tight, noncovalent complex, which is required for maintenance of a normal fVIII level in the circulation. Complex formation with vWf stabilizes association of the LCh and HCh within fVIII molecule (Wise, R. J., et al., J. Biol. Chem. 266:21948-21955 (1991)) and prevents fVIII from C2-domain mediated binding to phospholipid membranes (Gilbert, G. E., et al., J. Biol. Chem. 267:15861-15868 (1992)), activation by activated factor X (Koppelman, S. J., et al., J. Lab. Clin. Med. 123:585-593 (1994)) and from protein C-catalyzed inactivation (Fay, P. J., et al., J. Biol. Chem 266:2172-2177 (1991)). vWf comprises a series of high molecular weight, disulfide-bonded multimers with molecular weight values as high as 2×10⁷ Da (Hoyer, L. W. and Shainoff, J. R., Blood 55:1056-1059 (1980)) and circulates in plasma at 10 μg/ml or 50 nM, assuming a molecular mass of 270 kDa for vWf monomers (Girma, J.-P., et al., Biochemistry 25:3156-3163 (1986)). Since the concentration of fVIII in plasma is approximately 1 nM (Wion, K., et al., Nature 317:726-730 (1985)), one fVIII molecule is bound per 50 vWf monomers (Vlot, A. J., et al., Blood 85:3150-3157 (1995)).

[0275] Activation of fVIII by thrombin leads to dissociation of activated fVIII (fVIIIa) from vWf and to at least 100-fold increase of the cofactor activity. The fVIIIa is a A1/A2/A3-C1-C2 heterotrimer (Fay, P. J., et al., J. Biol. Chem 266:8957-8962 (1991)) in which domains A1 and A3 retain the metal ion linkage (FIG. 1) and the stable dimer A1/A3-C1-C2 is weakly associated with the A2 subunit through electrostatic forces (Fay, P. J., et al., J. Biol. Chem 266:8957-8962 (1991)). Spontaneous dissociation of the A2 subunit from the heterotrimer results in non-proteolytic inactivation of fVIIIa.

[0276] Infusion of fVIII/vWf complex or purified plasma or recombinant fVIII into patients with severe hemophilia A who do not have fVIII (Fijnvandraat, K., et al., Thromb. Haemostas. 77:298-302 (1997); Morfini, M., et al., Thromb. Haemostas. 68:433-435 (1992)) or in normal individuals (Over, J., et al., J. Clin. Invest. 62:223-234(1978)) results in a similar fVIII disappearance with a half-life of 12-14 hours. Although the complex between fVIII and vWf is crucial for normal half-life and level of fVIII in the circulation, the mechanisms associated with turnover of fVIII/vWf complex are not well defined. We proposed that fVIII/vWf complex is eliminated from plasma via clearance receptor and tested the possibility that this receptor is low density lipoprotein related protein receptor (LRP). Cellular endocytosis mediated by LRP was shown to be a mechanism of removal of a number of structurally unrelated ligands including several proteins related to coagulation or fibrilolysis. These ligands are: complexes of thrombin with antithrombin III (ATIII), heparin cofactor II (HC11) (Kounnas, M. Z., et al., J. Biol. Chem. 271:6523-6529 (1996)), protease nexin I (Knauer, M. F., et al., J. Biol. Chem. 272:12261-12264 (1997)), complexes of urokinase-type and tissue-type plasminogen activators (u-PA and t-PA, respectively) with plasminogen activator inhibitor (PAI1) Nykjaer, A., et at, J. Biol. Chem. 267:14543-14546 (1992);Orth, K, et al., Proc. Natl. Acad. Sci. 89:7422-7426 (1992)), thrombospondin (Mikhailenko, I., et al., J. Biol. Chem. 272:6784-6791 (1997)), tissue factor pathway inhibitor (TFPI) (Warshawsky, I., et at., Proc. Natl. Acad. Sci. 91:6664-6668 (1994)), and factor Xa (Narita, M., et al., Blood 91:555-560 (1998); Ho, G., et al., J. Biol. Chem 271:9497-9502 (1996)).

[0277] LRP, a large cell-surface glycoprotein identical to α₂-macroglobulin receptor (Strickland, D. K., et al., J. Biol. Chem. 265:17401-17404 (1990)), is a member of the low density lipoprotein (LDL) receptor family which also includes the LDL receptor, very low density lipoprotein (VLDL) receptor, vitellogenin receptor and glycoprotein 330 receptor. LRP receptor consists of the non-covalently linked 515 kDa α-chain (Herz, J., et al., EMBO J. 7:4119-4127 (1988)) containing binding sites for LRP ligands, and the 85 kDa transmembrane β-chain. Within the α-chain, cluster of cysteine-rich class A repeats is responsible for ligand binding (Moestrup, S. K., et al., J. Biol. Chem 268:13691-13696 (1993)). In contrast to the acidic ligand binding region in LRP, its ligands expose regions rich in positively charged amino acid residues (Moestrup, S. K., Biochim. Biophys. Acta 1197:197-213 (1994)). This type of binding and 31 class A repeats present in LRP may be responsible for its wide ligand diversity and ability to serve as a multi-ligand clearance receptor. LRP is expressed in many cell types and tissues including placenta, lung and brain (Moestrup, S. K., et al., Cell Tissue Res. 269:375-382 (1992)) and is a major endocytic receptor in the liver (Strickland, D. K., et al., FASEB J. 9:890-898 (1995)). A 39 kDa receptor-associated protein (RAP) binds to LRP with high affinity (K_(d)=4 nM (27)) and inhibits binding and LRP-mediated internalization and degradation of all ligands (Moestrup, S. K. Biochim. Biophys. Acta 1197:197-213 (1994); Williams, S. E., et al., J. Biol. Chem. 267:9035-9040 (1992)), therefore serving as a useful tool for testing whether LRP is involved in endocytosis of a given ligand.

[0278] In the present study we demonstrated that fVIII specifically binds to LRP, and that LRP mediates the internalization and subsequent degradation of fVIII in cultured fibroblasts and appears to be responsible for in vivo clearance of fVIII from circulation We also demonstrated that interaction of the A2 domain of fVIII with LRP is responsible for mediating catabolism of fVIII.

[0279] Experimental Procedures

[0280] Monoclonal Antibodies.

[0281] The monoclonal antibodies (mAbs) C4 (epitope within the fVIII light chain residues 1670-1684 (Foster, P.A., et al., J. Biol. Chem 263:5230-5234 (1988))), C5 (epitope within A1 residues 351-361) and T5 (epitope within the residues 701-740 (Fulcher, C. A., et al., J. Clin. Invest. 76:117-124 (1985))) were kindly provided by Dr. Carol Fulcher (Scripps Clinic and Research Foundation, La Jolla, Calif.). The anti-A2 mAb 8860 was generously provided by Baxter/Hyland. Mab 413 (epitope within A2 domain residues 484-509 (Healey, et al., J. F., J. Biol. Chem 270:14505-14509 (1995))) was prepared as described previously (Saenko, E. L., et al, J. Biol. Chem 269:11601-11605 (1994)).

[0282] Proteins.

[0283] LRP was isolated from human placenta as described (Ashcom, J. D., et al., J. Cell Biol. 110:1041-1048 (1990)). Human RAP was expressed in bacteria and purified as described (Williams, S. E., et al., J. Biol. Chem. 267:9035-9040 (1992)). FVIII was purified from therapeutic concentrates of Method M, American Red Cross (Saenko, E. L., et al., J. Biol. Chem 271:27424-27431 (1996)). HCh and LCh were prepared from fVIII as described previously (Saenko, E. L. and Scandella, D., J. Biol. Chem 272, 18007-18014 (1995)). Purification of the A1/A3-C1-C2 dimer and A2 subunit was performed using ion exchange chromatography of thrombin activated fVIII on a Resource S column (Pharmacia) (Fay, P. T., et al., J. Biol. Chem 268,17861-17866 (1993)). Residual A2 present in the A1/A3-C1-C2 preparation was removed by its passage over an immobilized mAb 8860 column equilibrated in 20 mM Tris, pH 7.4, 0.15 M NaCl, 5 mM CaCl₂.

[0284] Radiolabeling of fVIII and Synthetic Peptides.

[0285] Prior to iodination fVIII and A2 were dialyzed into 0.2 M sodium acetate, 5 mM calcium nitrate, pH 6.8 (iodination buffer). Five μg of fVIII in 30 μl of iodination buffer were added to lactoperoxidase beads (Worthington Biochemical Corp.), 5 μl of Na¹²⁵I (100 mCi/ml, Amersham), and 5 μl of 0.03% H₂O₂ (Mallincrodt) and incubated for 4 min. Free Na¹²⁵I was removed by chromatography on a PD10 column (Pharmacia). The specific radioactivity of fVIII and A2 was 3.5-5 μCi/μg of protein. The activity of ¹²⁵I-fVIII determined in the one-stage clotting assay (3740 units/μg) was similar to that of unlabeled fVIII.

[0286] Solid-Phase Binding Assays.

[0287] Homologous and heterologous ligand displacement assays were performed as previously described (Williams, S. E., et al., J. Biol. Chem. 267:9035-9040 (1992)). Microtiter wells were coated with purified LRP or BSA (3 μg/ml) in 50 mM Tris, 0.15 M NaCl, pH 8.0, for 16 h and then blocked with 3% BSA in TBS. Coated wells were incubated with ¹²⁵I-A2 or ¹²⁵I-fVIII in 20 mM Tris-buffered saline pH 7.4, containing 5 mM CaCl₂, 0.05% Tween-20 in the presence or absence of unlabeled competitors for 1 h at 37° C. The radioactivity bound to the wells was counted using a γ-counter (Pharmacia). Affinity constants were derived from homologous and heterologous displacement data using the computer program LIGAND (Munson, P T and Rodbard, D. Anal. Biochem. 107:220-239 (1980)).

[0288] Cell-Mediated Ligand Internalization and Degradation Assays.

[0289] A normal mouse embryonic fibroblast line (MEF) and a mouse embryonic fibroblast cell line that is genetically deficient in LRP biosynthesis (PEA 13) were obtained from Dr. Joachim Herz (University of Texas Southwestern Medical Center, Dallas, Tex.) and maintained as described (Willnow, T. E. and Herz, J., J. Cell Sci. 107:719-726 (1994)). Cells were seeded at 1×10⁵ cells/well and allowed to grow for 24 h at 37° C., 5% CO₂. Cellular internalization and degradation assays were conducted as described previously (Kounnas, M. Z., et al, J. Biol. Chem. 270:9307-9312 (1995)). Internalization and degradation of the ¹²⁵I-labeled fVIII and A2 was measured after incubation for indicated time intervals at 37° C. in 0.5 ml of Dulbecco's modified medium (Gibco BRL) containing 2% BSA. Internalization was defined as radioactivity that is resistant to release from cells by trypsin (50 μg/ml) and proteinase K (50 μg/ml) (Sigma) in a buffer containing 5 mM EDTA. This treatment was previously shown to release radioligand bound to cell surface (Kounnas, M. Z., et al., J. Biol. Chem. 270:9307-9312 (1995)) and therefore the ligand remained associated with cells after this treatment was considered as internalized. Degradation was defined as radioactivity in the medium that is soluble in 10% trichloroacetic acid. The value of degradation was corrected for non-cellular mediated degradation by subtracting the amount of degradation products generated in parallel wells lacking cells.

[0290] Clearance of ¹²⁵I-A2 Domain and ¹²⁵I-fVIII/vWf Complex from Mouse Plasma.

[0291] The complex of ¹²⁵I-labeled fVIII with vWf in the presence or absence of RAP (in a total volume 250 μl) was injected in a tail vein of BALB/C mice over a period of approximately 20 seconds. At selected time intervals following injection (1, 3, 6, and 18 min), blood (50 μl) was withdrawn from the orbital plexus into 10 μl of 100 mM EDTA, and the radioactivity of the aliquot was determined. The percentage of ligand remaining in circulation was calculated considering radioactivity of the aliquot taken at 1 min after injection as 100%. The clearance of each preparation was examined in two mice and the results were averaged. At the end of experiment, animals were sacrificed, liver lobules and kidneys were excised and weighed, followed by measuring the radioactivity in these tissues.

[0292] Results

[0293] Factor VIII Binds to LRP and its Binding is Prevented by RAP.

[0294] The ability of fVIII to bind to LRP in vitro was examined in homologous displacement binding assay. In the assay, binding of ¹²⁵I-fVIII (1 nM) to purified LRP, but not to BSA-coated wells, was competed (>90%) by an excess of unlabeled fVIII (FIG. 15A). The quantitative data regarding fVIII interaction with LRP were derived from the homologous displacement of ¹²⁵I-fVIII by unlabeled fVIII, which was adequately described by a model containing a single class of fVIII binding sites with K_(d) of 116 nM. To elucidate whether fVIII in a complex with vWf is also able to bind to LRP, we tested the effect of vWf on ¹²⁵I-fVIII binding to immobilized LRP. In this experiment, ¹²⁵I-fVIII was preincubated with vWf for 30 min at 37° C. to allow complex formation prior to its addition to LRP coated wells. As shown in FIG. 15A, ¹²⁵I-fVIII binding to LRP was not inhibited by vWf up to the concentration of 1000 nM, which is 20-fold higher than its concentration in plasma (50 mM (Vlot, A. J., et al., Blood 85:3150-3157 (1995))). This indicates that the complex formation with vWf does not affect fVIII ability to bind to LRP.

[0295] RAP, the antagonist of LRP-ligand binding, completely inhibited the binding of ¹²⁵I-fVIII to LRP-coated wells with K_(i) of 2.5 nM (FIG. 15B), a value similar to the previously determined affinity (4 nM) of RAP for LRP (Strickland, D. K., et al., J. Biol. Chem. 265:17401-17404 (1990)). Together, these results demonstrate specific fVIII binding to LRP.

[0296] The Amino Acid Residues 484-509 within the fVIII A2 Domain are Responsible for fVIII Binding to Purified LRP.

[0297] In order to localize fVIII region(s) involved in interaction with LRP, binding between ¹²⁵I-fVIII and immobilized LRP was competed by unlabeled fVIII fragments. As shown in FIG. 16, HCh and A2 domain of fVIII, but not LCh (AR-A3-C1-C2) or A1/A3-C1-C2 dimer, displaced ¹²⁵I-fVIII from LRP in the heterologous ligand displacement assay. The K_(i) values determined for the HCh and A2 were similar, 120nM and 132 nM, respectively. The similarity of the above K_(d) value for fVIII binding to LRP and the K_(i) value for inhibition of this binding by isolated A2 subunit indicates that A2 domain of HCh is responsible for fVIII binding to LRP.

[0298] To localize the region of the A2 domain responsible for the interaction with LRP, we tested the effect of anti-A2 monoclonal antibodies with known epitopes on fVIII/LRP binding. FIG. 17A shows that mAb 413 (epitope within the A2 domain residues 484-509 (Healey, J. F., et al., J. Biol. Chem 270:14505-14509 (1995))) but not mAb T5 (epitope within the A2 domain residues 701-740 (Fulcher, C. A., et al., J. Clin. Invest. 76:117-124 (1985))) is able to block fVIII/LRP interaction. The concentration of mAb 413 required for 50% inhibition of ¹²⁵I-fVIII/LRP binding was 2.5 nM. The low molar excess (2.5-fold) of mAb 413 over fVIII required for 50% inhibition of fVIII/LRP binding is consistent with a previously reported high affinity of mAb 413 for fVIII (Lollar, P., et al, J. Clin. Invest. 93:2497-2504 (1994)). In a control experiment, mAbs C5 (epitope within A1 residues 351-361) and C4 (epitope within LCh residues 1670-1684 (Foster, P. A., et al., J. Biol. Chem 263:5230-5234 (1988))) did not have any effect on fVIII binding to LRP (data not shown), which is consistent with the lack of participation of A1 and LCh in fVIII binding to LRP.

[0299] Since it was previously demonstrated that mAb 413 recognizes synthetic peptide with a human fVIII sequence 484-509 (Healey, J. F., et al., J. Biol. Chem 270:14505-14509 (1995)), we tested if the region of the A2 domain encompassed by peptide 484-509 is involved in binding to LRP. As seen from FIG. 17B, the synthetic peptide 484-509, but not the control A2 peptide 432-456, inhibited fVIII binding to LRP in a dose-dependent fashion, indicating that the region 484-509 of the A2 domain contains important residues for fVIII binding to LRP. In a control experiment, no binding of ¹²⁵I-fVIII to BSA-coated wells was observed in the presence of peptide 484-509 (FIG. 17B).

[0300] Internalization and Degradation of ¹²⁵I-fVIII Complex with vWf by Cultured Fibroblasts is Mediated by LRP.

[0301] Since the data presented above demonstrated specific interaction between fVIII and LRP, and vWf does not interfere with this interaction, we hypothesized that LRP may be also capable of mediating the cellular intenalization of ¹²⁵I-fVIII from its complex with vWf. To examine this hypothesis, cellular uptake and degradation experiments were conducted in mouse embryonal fibroblasts (NEF) which express LRP and in PEA 13 fibroblasts that are genetically deficient in LRP (Willnow, T. E. and Herz, J. J. Cell Sci. 107:719-726 (1994)). The ¹²⁵I-fVIII/vWf complex was prepared by 30 min (37° C.) incubation of ¹²⁵I-fVIII with vWf at their plasma concentrations of 1 nM and 50 nM, respectively. As shown in FIGS. 18A-18B, MEF cells, but not PEA 13 cells lacking LRP, were capable of internalizing and degrading ¹²⁵I-fVIII in the presence of vWf. Further, internalization and degradation of ¹²⁵I-fVIII by MEF but not by PEA 13 fibroblasts was inhibited by RAP, an antagonist of ligand binding to LRP. The ability of RAP to block the uptake and degradation of ¹²⁵I-fVIII/vWf in MEF cells and inability of PEA 13 cells to efficiently mediate uptake and degradation indicates that LRP is the mediator of ¹²⁵I-fVIII/vWf catabolism. To further characterize the degradation pathway of fVIII in the MEF cells, we tested the effect of chloroquine (an agent that blocks lysosomal degradation) on ¹²⁵I-fVIII degradation. As seen from FIG. 18B, the degradation of ¹²⁵I-fVIII is completely inhibited by chloroquine.

[0302] To elucidate if fVIII internalization in the absence of vWf is also mediated by LRP, we measured the internalization and degradation of isolated ¹²⁵I-fVIII (FIGS. 19A-19B). As seen from FIGS. 19A-19B, both internalization and degradation of isolated ¹²⁵I-fVIII by MEF fibroblasts is approximately 2-fold higher than that in the presence of vWf. RAP inhibited the internalization and degradation of ¹²⁵I-fVIII to a lesser degree than those of ¹²⁵I-fVIII/vWf complex and, in addition, LRP-deficient PEA 13 fibroblasts were able to internalize and degrade isolated ¹²⁵I-fVIII. This indicates that the LRP-mediated pathway is not the sole mechanism of fVIII internalization and degradation in the absence of vWf.

[0303] To determine whether vWf bound to fVIII is also internalized and degraded by MEF cells, internalization and degradation of ¹²⁵I-labeled vWf complexed with fVIII was measured. As shown in FIGS. 19A-19B, the amounts of internalized and degraded ¹²⁵I-vWf by both MEF and PEA 13 cells were less than 5% of the corresponding amounts of ¹²⁵I-fVIII catabolized from its complex with vWf under the same experimental conditions. This indicates that vWf does not follow fVIII in the LRP-mediated pathway and possibly dissociates from fVIII at an early stage of endocytosis, prior to entry of the complex into endosomal compartments.

[0304] The A2 Subunit of fVIII Inhibits Endocytosis and Degradation of ¹²⁵I-fVIII/vWf by MEF Cells.

[0305] Since we have demonstrated above that the A2 subunit of fVIII prevents an in vitro interaction between LRP and fVIII, we examined if A2 can also inhibit LRP-mediated internalization and degradation of fVIII/vWf complex by MEF cells. FIGS. 20A-20B demonstrate that a 1000-fold excess of A2 subunit over ¹²⁵I-fVIII/vWf complex effectively inhibit internalization (by >70% after 4 hours) and degradation (by >60% after 4 hours) of this complex. In contrast, A1/A3-C1-C2 heterodimer, which did not inhibit fVIII interaction with purified LRP in the above experiments, did not have any effect on ¹²⁵I-fVIII endocytosis and degradation by MEF cells (FIGS. 20A-20B).

[0306] To confirm that the inhibitory effect of the A2 subunit results from its direct competition with ¹²⁵I-fVIII/vWf complex for LRP-mediated internalization and degradation, we tested whether MEF cells are able to internalize and degrade isolated A2 subunit. As shown in FIGS. 21A-21B, ¹²⁵I-A2 is readily internalized and degraded by LRP-expressing MEF cells. Both the internalization and degradation of the ¹²⁵I-labeled A2 were blocked in the presence of RAP. In contrast, LRP-deficient PEA 13 cells were unable to internalize or degrade ¹²⁵I-A2 (FIGS. 21A-21B), confirming that catabolism of the A2 subunit is LRP-mediated.

[0307] To verify that LRP-mediated internalization and degradation of the A2 domain was not the unique feature of the MEF cells, we tested ¹²⁵I-labeled A2 internalization and degradation by smooth muscle cells (SMC) and alveolar epithelial cells (T2), which also express LRP on their surfaces (Moestrup, S. K., Cell Tissue Res. 269:375-382 (1992)). As shown in FIGS. 11C and D, RAP effectively inhibited both internalization of ¹²⁵I-A2 by SMC and T2 (by 81% and 64%, respectively), and its degradation (by 78% and 68%), indicating that these processes were mediated by LRP.

[0308] Thus, the data shown in FIGS. 20A-20B and 21A-21B demonstrate that LRP is capable of binding fVIII via its A2 domain and of mediating fVIII endocytosis leading to lysosomal degradation.

[0309] Effect of RAP on the Plasma Clearance of ¹²⁵I-fVIII and ¹²⁵I-A2.

[0310] To determine whether LRP is capable of catabolizing the isolated FVIII A2 subunit and whole fVIII from its complex with vWf in vivo, the effect of RAP on the clearance rates in mice of ¹²⁵I-fVIII/vWf complex and ¹²⁵I-A2 was tested. As shown in FIG. 22A, RAP increased the half-life of both ¹²⁵I-A2 and ¹²⁵I-fVHIII in mouse plasma by approximately 4 and 2.5-fold, respectively. In addition, in the absence of RAP, most of radioactivity was found in thc liver but not in kidney, consistent with LRP presence in high abundance in hepatic tissues (Strickland, D. K., et al., FASEB J. 9:890-898 (1995)). Thus, our data show that a RAP-sensitive hepatic receptor, LRP, plays a major role in the removal of fVIII and its A2 subunit from circulation.

[0311] Discussion

[0312] In the present study we demonstrated that LRP mediates the internalization and degradation of human fVIII in a model system using LRP-expressing cells and that it is responsible for fVIII clearance in vivo. This conclusion is based on several independent observations. First, we found that fVIII directly binds to purified LRP immobilized on microtiter wells, and that this binding is competed by RAP, an antagonist of ligand binding to LRP. Second, ¹²⁵I-fVIII is internalized from its complex with vWf by mouse fibroblasts expressing LRP (MEF cells), but not by mouse fibroblasts genetically deficient in LRP (PEA 13 cells). Third, we demonstrated that RAP effectively inhibited the cellular uptake and degradation of ¹²⁵I-fVIII from its complex with vWf by MEF cells and the in vivo clearance of ¹²⁵I-fVIII from circulation in mice.

[0313] Our studies revealed that the A2 domain of fVIII is responsible for its interaction with LRP, since only A2 domain and HCh, which contains the A2 domain, were able to inhibit the interaction of ¹²⁵I-fVIII with LRP in a purified system. Thus, it was concluded that A2 is responsible for fVIII binding to LRP. Based on the observation that vWf did not inhibit fVIII binding to LRP, we proposed that LRP may internalize fVIII from its complex with vWf. Indeed, mouse embryonic fibroblasts (MEF) that express LRP, but not fibroblasts genetically deficient in LRP, were able to internalize and degrade ¹²⁵I-fVIII in the presence of vWf. These processes were competed by RAP and the A2 subunit of fVIII, indicating that cellular internalization and degradation were mediated by the interaction of the A2 domain of fVIII with LRP. The physiological relevance of the observations utilizing the LRP-expressing cell model system was supported by in vivo clearance studies of ¹²⁵I-fVIII/vWf complex in mice which demonstrated that RAP prolonged the half-life of ¹²⁵I-fVIII in circulation by 2.5-fold, indicating that a RAP-sensitive receptor, most likely LRP, is responsible for the clearance of fVIII from plasma.

[0314] Further localization of the region in the A2 domain responsible for binding to purified LRP was initiated by the finding that a monoclonal antibody with an epitope within A2 domain residues 484-509 completely inhibited fVIII interaction with LRP. Inhibition of fVIII/LRP binding by synthetic peptide with a human fVIII sequence 484-509 indicated that the region of the A2 domain is likely to be directly involved in fVIII binding to purified LRP.

[0315] The region 484-509 contains 6 positively charged residues, Lys at positions 493, 496 and 499 and Arg at positions 484, 489 and 490. Basic residues in lipoprotein lipase (Chappell, D. A., et al., J. Biol. Chem. 268:14168-14175 (1993)), u-PA-PAI-1 complex (Rodenburg, K. W., et al., Biochem. J. 329:55-63 (1998)), and α₂-macroglobulin (Howard, G. C., et al., J. Biol. Chem 271:14105-14111 (1996)) were previously shown to be critical for electrostatic interaction with LRP. Alanine substitution of the basic amino acid residues in lipoprotein lipase (Williams, S. E., et al., J. Biol. Chem. 269:8653-8658 (1994)), u-PA/PAI-I complex (Rodenburg, K. W., et al., Biochem. J. 329:55-63 (1998)) and in the receptor binding fragment from α₂-macroglobulin (Howard, G. C., et al., J. Biol. Chem 271:14105-14111 (1996)) lead to a considerable reduction of affinity for ligand binding to LRP and partial (Rodenburg, K. W., et al., Biochem. J. 329:55-63(1998)) or complete (Howard, G. C., et al., J. Biol. Chem 271:14105-14111 (1996)) inhibition of internalization and degradation of the mutants. Therefore, Ala or other amino acid substitutions within the 484-509 region of the recombinant fVIII are useful for reduction of the rate of its LRP-mediated endocytosis and generation of the fVIII mutants with a longer life in the circulation.

[0316] FVIII binds to purified LRP with an affinity of 116 nM, which is much lower than the concentration of fVIII/vWf complex in plasma (1 nM; Wion, K., et al., Nature 317:726-730(1985)). FVIII affinity for LRP is similar to that of the complexes of serine proteases with inhibitors such as ATIII/thrombin (Kounnas, M. Z., et al., J. Biol. Chem. 271:6523-6529 (1996)), HCII/thrombin and α₁-antitrypsin/trypsin (Kounnas, M. Z., et al., J. Biol. Chem. 271:6523-6529 (1996)), which also bind to LRP with affinities of 80-120 nM, and weaker than measured for other LRP ligands. It was shown (Kounnas, M. Z., et al., J. Biol. Chem. 271:6523-6529 (1996)) that internalization and degradation of the above low affinity LRP ligands at their 1 nM concentration by MEF cells occur at a lower rate than that of the u-PA/PAI-I complex which binds to LRP with high affinity (K_(d)<1 nM). Therefore, relatively low affinity of fVIII for LRP is responsible for a slow rate of fVIII internalization and degradation by MEF cells, which is comparable to the rate of ATIII/thrombin, HCII/thrombin and α1-antitrypsin/trypsin degradation at 1 nM concentration of each ligand. The low affinity of fVIII for LRP may also be a necessary requirement for the relatively long fVIII half-life (12-14 h) in plasma of normal individuals (Over, J., et al., J. Clin. Invest. 62:223-234 (1978)). Alternatively, the low fVIII affinity for LRP may be compensated by concentration of fVIII molecules on the membrane of LRP-expressing cells, for example, via interaction with cell-surface proteoglycans which have been shown to facilitate the uptake of a number of LRP ligands including lipoprotein lipase (Chappell, D. A., et al., J. Biol. Chem. 268:14168-14175 (1993)), hepatic lipase (Kounnas, M. Z., et al., J. Biol. Chem. 270:9307-9312 (1995)), and thrombospondin (Mikhailenko, I., et al., J. Biol. Chem. 270:9543-9549 (1995); Mikhailenko, I., et al., J. Biol. Chem. 272:6784-6791 (1997)).

[0317] We found that internalization and degradation of isolated fVIII by MEF cells was greater than the corresponding processes for fVIII bound to vWf. In addition, catabolism of the isolated fVIII by MEF cells was only partially inhibited by RAP, indicating that LRP-mediated endocytosis of fVIII is not the sole mechanism of fVIII clearance in the absence of vWf. Our data suggest that in the presence of vWf, which blocks C2 domain-mediated fVIII binding to phospholipid membranes (Saenko, E. L. and Scandella, D., J. Biol. Chem 270:13826-13833 (1995)), fVIII binds only to LRP, whereas in the absence of vWf, fVIII binds both to LRP and to an unidentified cell membrane component. The latter binding may lead to fVIII internalization via a RAP-independent pathway, which may be mediated by unidentified receptor as it was previously proposed for hepatic lipase (Kounnas, M. Z., et al., J. Biol. Chem. 270:9307-9312 (1995)). Since we found that ¹²⁵I-vWf is not internalized by MEF cells, we propose a model for fVIII endocytosis where fVIII/vWf complex binds to LRP and then vWf dissociates from fVIII during the early stage of fVIII endocytosis, i.e. during the formation of coated pits. Since the half-life for the dissociation of fVIII/vWf complex is about 1 hour (Saenko, E. L. and Scandella, D., J. Biol Chem 272, 18007-18014 (1995)), vWf may delay LRP-mediated endocytosis of fVIII according to the proposed model.

[0318] Faster catabolism of fVIII in the absence of vWf is consistent with a demonstrated shorter half-life of fVIII in patients with severe von Willebrand disease (vWD) lacking plasma vWf than that in hemophilia A patients, who have normal levels of vWf (Morfini, M., et al., Thromb. Haemostas. 70:270-272 (1993); Lethagen, S., et al., Ann. Hematol. 65:253-259 (1992)). Moreover, the half-life of fVIII in vWD patients was prolonged by the presence of vWf in the infused fVIII preparation (Lethagen, S., et al., Ann. Hematol. 65:253-259 (1992)). The above observations were previously explained by vWf-mediated stabilization of fVIII by binding to vWf (Wise, R. J., et al, J. Biol. Chem. 266:21948-21955 (1991)) and via secondary vWf-mediated release of endogenous fVIII (Wise, R. J., et al., J. Biol. Chem. 266:21948-21955 (1991); Kaufman, R. J., Mol. Cell. Biol. 9:1233-1242 (1989)). Our data suggest that in addition to the above effects, vWf may reduce the rate of fVIII clearance by preventing a LRP-independent pathway and limiting fVIII clearance to a LRP-mediated pathway.

[0319] The activity of the factor X activation complex (factor Xase), consisting of membrane-bound activated fVIIIa and factor IXa, can be down regulated by inactivation of fVIIIa. The latter occurs via proteolytic degradation of fVIII by activated protein C, factor Xa and factor IXa, and via spontaneous but reversible dissociation of the A2 subunit from fVIIIa heterotrimer (Fay, P. J. and Smudzin, T. M., J. Biol. Chem 267:13246-13250 (1992)). Dissociation of the fVIIIa heterotrimer may be accelerated by LRP mediated internalization of the A2 domain, and therefore complement regulation of fVIIIa activity at the sites of coagulation. This hypothesis is supported by the availability of LRP at these sites, since LRP is exposed on the surface of monocytes and macrophages (Moestrup, S. K., et al., Exp. Cell. Res. 190:195-203 (1990); Moestrup, S. K., et al., Cell Tissue Res. 269:375-382 (1992)) and upon vascular injury on fibroblasts and smooth muscle cells (Moestrup, S. K., et al., Cell Tissue Res. 269:375-382 (1992)). In addition, it was recently shown that isolated A2 but not isolated A1 and A3-C1-C2 subunits of activated fVIII is able to accelerate factor IXa-catalyzed conversion of factor X by approximately 100-fold (Fay, P. J. and Koshibu, K., Blood 92:353a (abstract) (1998)). Even though acceleration of the factor X activation by A2 is only 1% of that in the presence of heterotrimeric activated fVIII (A1/A2/A3-C1-C2) (Fay, P. J. and Koshibu, K., Blood 92:353a (abstract) (1998)), it is possible that LRP-mediated removal of A2, dissociated from fVIIIa bound to a phospholipid membrane at the site of coagulation, is important to prevent activation of factor X not in the place of the coagulation event.

[0320] In summary, the current study demonstrates that LRP can bind fVIII/vWf complex and mediate uptake of fVIII from it. In vivo clearance studies shows that LRP indeed functions to remove fVIII from plasma.

Example 4

[0321] Experiments on the Development of Recombinant fVIII Molecule with Extended Lifetime in Circulation.

[0322] Since recombinant fVIII products are widely used for fVIII replacement therapy in hemophiliacs who have decreased or nonfunctional fVIII, the generation of mutant(s) with a prolonged lifetime is a promising approach to increase the efficacy and reduce the cost of fVIII infusion therapy. A 39 kDa receptor associated protein (RAP) binds reversibly to LRP and inhibits the binding of other ligands and therefore serves as a useful tool for testing whether LRP is involved in endocytosis of a given ligand. We found that fVIII binding to LRP is inhibited by RAP, confirming the specificity of this interaction. Since von Willebrand factor (vWf), bound to fVIII in the circulation, does not inhibit fVIII binding to purified LRP, we proposed that the removal of fVIII/vWf complex from circulation may also be LRP-mediated. This role of LRP was supported by our finding that the half-life of human ¹²⁵I-fVIII/vWf complex in mice was 2.5-times prolonged in the presence of RAP.

[0323] Based on our finding that fVIII amino acids 484-509 were important for fVIII binding to LRP, these amino acids are also important for LRP-mediated endocytosis. To identify the key fVIII amino acids required for endocytosis, single residues 484-509 are mutated to Ala in the B-domain deleted fVIII (B(−) fVIII). Since the basic residues are commonly involved in ligand binding to LRP, six basic residues within 484-509 (3 Lys and 3 Arg) are mutated. U.S. Pat. No. 55,859,204 discloses the substitution to Ala of three of these residues (Arg⁴⁸⁴ Lys⁴⁹³ and Arg⁴⁹⁰); however the other 3 residues—Arg⁴⁹⁰, Lys⁴⁹⁶ and Lys⁴⁹⁹—were not substituted. Thus, these residues, individually and in combination, are mutated to Ala. In particular, each of three Arg and each of three Lys are mutated by pairs (this implies preparation of 9 additional fVIII Ala double-mutants).

[0324] It is then determined whether the endocytosis by LRP-expressing cells of vWf complexes with B(−) fVIII mutant(s) is reduced compared to that of wild-type B(−) fVIII/vWf. Some mutations result in a decreased rate of internalization and a longer in vivo half-life of the complex of the B− fVIII mutant with vWf in plasma of mice compared to that of wild type B− fVIII/vWf complex. The data of the in vivo experiments performed in normal and fVIII-deficient mice is mathematically analyzed using biphasic time-course clearance model and equations approximating interspecies scaling which allow the prediction fVIII half-life in humans (Toxicology and Applied Pharmacology 136:75-78 (1996)).

[0325] Clearance of mutant fVIII in vWf-deficient mice which lack fVIII in circulation (a mouse model for severe von Willebrand disease is described in Proc. Natl. Acad. Sci. USA 95:9524-9529 (1998)) is also analyzed. These experiments are aimed at determining mutant fVIII's prolonged half-life in the absence of vWf. Factor VIII interaction with endothelial cells is also analyzed, since this interaction leads to fVIII internalization. In experiments using fluorescent microscopy techniques we observed uptake of fVIII by endothelial cells. Since a fine equilibrium exists in circulation between fVIII bound to vWf and fVIII bound and internalized by endothelial cells, fVIII interaction with the phospholipid endothelial cell membrane is an important factor influencing the concentration of fVIII (and hence its half-life) in circulation following fVIII injection.

[0326] Therefore, individual amino acids that play a role in fVIII binding to vWf and to phospholipid are identified within the previously localized fVIII phospholipid binding site (C2 domain region 2303-2332). We identify the amino acids playing an important role in fVIII binding to phospholipid but not to vWf. The amino acids which participate in fVIII binding to vWf and to phospholipids are selected based on the following observations. The homology search between the C2 domain of fVIII and the corresponding region of the discoidin and a family of homologous proteins, containing the so called DS domain, has revealed the fVIII C2 domain sequences involved in the formation of β-structures. In addition, it has been shown that the synthetic fVIII peptide 2310-2320 in which residues 2310 and 2320 are covalently linked to reproduce the corresponding loop structure within the C2 domain, competes for fVIII binding with vWf or phospholipid. Therefore, residues within the 2311-2319 region are mutated to Ala, and other amino acids. Since fV, a fVIII homolog, does not bind to vWf, we mutate only five residues which are unique within the 2311-2319 region of fVIII. The mutants are tested for binding to vWf and phospholipid, which identifies the fVIII residues playing a key role in binding to these ligand.

[0327] Clearance of the fVIII mutants with reduced phospholipid binding is compared with that of wt-fVIII in normal and hemophilic mice to determine the contribution of the phospholipid-dependent fVIII clearance component to total fVIII clearance.

[0328] The mutations within the C2 domain region 2310-2320 prove to be effective for extension of fVIII lifetime in circulation, so we generate mutant fVIII in which both the C2 domain mutation(s) (positions 2310-2320) and mutation(s) within the A2 (positions 484-509) are combined.

[0329] To test the designed extended lifetime fVIII for gene therapy purposes, the mutated fVIII gene is inserted in a virus-based vector; and delivered into hemophilia A mice. The time course of the fVIII in vivo expression level is assessed as follows: the number of the gene copies per cell (hepatic), the gene transcription level, fVIII activity and the antigen level are determined. Since it was shown that high titer antibodies increase clearance of fVIII (Br. J. Hematol. 93:688-693 (1996)), we examine the immune response against the extended lifetime fVIII. We also compare its half-life in circulation in hemophilia A mice which formed antibodies against wild type fVIII.

1 5 1 8967 DNA Homo sapiens sig_peptide (110)..(166) mat_peptide (167)..(7162) CDS (110)..(7162) 1 cttttcatta aatcagaaat tttacttttt tcccctcctg ggagctaaag atattttaga 60 gaagaattaa ccttttgctt ctccagttga acatttgtag caataagtc atg caa ata 118 Met Gln Ile gag ctc tcc acc tgc ttc ttt ctg tgc ctt ttg cga ttc tgc ttt agt 166 Glu Leu Ser Thr Cys Phe Phe Leu Cys Leu Leu Arg Phe Cys Phe Ser -15 -10 -5 -1 gcc acc aga aga tac tac ctg ggt gca gtg gaa ctg tca tgg gac tat 214 Ala Thr Arg Arg Tyr Tyr Leu Gly Ala Val Glu Leu Ser Trp Asp Tyr 1 5 10 15 atg caa agt gat ctc ggt gag ctg cct gtg gac gca aga ttt cct cct 262 Met Gln Ser Asp Leu Gly Glu Leu Pro Val Asp Ala Arg Phe Pro Pro 20 25 30 aga gtg cca aaa tct ttt cca ttc aac acc tca gtc gtg tac aaa aag 310 Arg Val Pro Lys Ser Phe Pro Phe Asn Thr Ser Val Val Tyr Lys Lys 35 40 45 act ctg ttt gta gaa ttc acg gat cac ctt ttc aac atc gct aag cca 358 Thr Leu Phe Val Glu Phe Thr Asp His Leu Phe Asn Ile Ala Lys Pro 50 55 60 agg cca ccc tgg atg ggt ctg cta ggt cct acc atc cag gct gag gtt 406 Arg Pro Pro Trp Met Gly Leu Leu Gly Pro Thr Ile Gln Ala Glu Val 65 70 75 80 tat gat aca gtg gtc att aca ctt aag aac atg gct tcc cat cct gtc 454 Tyr Asp Thr Val Val Ile Thr Leu Lys Asn Met Ala Ser His Pro Val 85 90 95 agt ctt cat gct gtt ggt gta tcc tac tgg aaa gct tct gag gga gct 502 Ser Leu His Ala Val Gly Val Ser Tyr Trp Lys Ala Ser Glu Gly Ala 100 105 110 gaa tat gat gat cag acc agt caa agg gag aaa gaa gat gat aaa gtc 550 Glu Tyr Asp Asp Gln Thr Ser Gln Arg Glu Lys Glu Asp Asp Lys Val 115 120 125 ttc cct ggt gga agc cat aca tat gtc tgg cag gtc ctg aaa gag aat 598 Phe Pro Gly Gly Ser His Thr Tyr Val Trp Gln Val Leu Lys Glu Asn 130 135 140 ggt cca atg gcc tct gac cca ctg tgc ctt acc tac tca tat ctt tct 646 Gly Pro Met Ala Ser Asp Pro Leu Cys Leu Thr Tyr Ser Tyr Leu Ser 145 150 155 160 cat gtg gac ctg gta aaa gac ttg aat tca ggc ctc att gga gcc cta 694 His Val Asp Leu Val Lys Asp Leu Asn Ser Gly Leu Ile Gly Ala Leu 165 170 175 cta gta tgt aga gaa ggg agt ctg gcc aag gaa aag aca cag acc ttg 742 Leu Val Cys Arg Glu Gly Ser Leu Ala Lys Glu Lys Thr Gln Thr Leu 180 185 190 cac aaa ttt ata cta ctt ttt gct gta ttt gat gaa ggg aaa agt tgg 790 His Lys Phe Ile Leu Leu Phe Ala Val Phe Asp Glu Gly Lys Ser Trp 195 200 205 cac tca gaa aca aag aac tcc ttg atg cag gat agg gat gct gca tct 838 His Ser Glu Thr Lys Asn Ser Leu Met Gln Asp Arg Asp Ala Ala Ser 210 215 220 gct cgg gcc tgg cct aaa atg cac aca gtc aat ggt tat gta aac agg 886 Ala Arg Ala Trp Pro Lys Met His Thr Val Asn Gly Tyr Val Asn Arg 225 230 235 240 tct ctg cca ggt ctg att gga tgc cac agg aaa tca gtc tat tgg cat 934 Ser Leu Pro Gly Leu Ile Gly Cys His Arg Lys Ser Val Tyr Trp His 245 250 255 gtg att gga atg ggc acc act cct gaa gtg cac tca ata ttc ctc gaa 982 Val Ile Gly Met Gly Thr Thr Pro Glu Val His Ser Ile Phe Leu Glu 260 265 270 ggt cac aca ttt ctt gtg agg aac cat cgc cag gcg tcc ttg gaa atc 1030 Gly His Thr Phe Leu Val Arg Asn His Arg Gln Ala Ser Leu Glu Ile 275 280 285 tcg cca ata act ttc ctt act gct caa aca ctc ttg atg gac ctt gga 1078 Ser Pro Ile Thr Phe Leu Thr Ala Gln Thr Leu Leu Met Asp Leu Gly 290 295 300 cag ttt cta ctg ttt tgt cat atc tct tcc cac caa cat gat ggc atg 1126 Gln Phe Leu Leu Phe Cys His Ile Ser Ser His Gln His Asp Gly Met 305 310 315 320 gaa gct tat gtc aaa gta gac agc tgt cca gag gaa ccc caa cta cga 1174 Glu Ala Tyr Val Lys Val Asp Ser Cys Pro Glu Glu Pro Gln Leu Arg 325 330 335 atg aaa aat aat gaa gaa gcg gaa gac tat gat gat gat ctt act gat 1222 Met Lys Asn Asn Glu Glu Ala Glu Asp Tyr Asp Asp Asp Leu Thr Asp 340 345 350 tct gaa atg gat gtg gtc agg ttt gat gat gac aac tct cct tcc ttt 1270 Ser Glu Met Asp Val Val Arg Phe Asp Asp Asp Asn Ser Pro Ser Phe 355 360 365 atc caa att cgc tca gtt gcc aag aag cat cct aaa act tgg gta cat 1318 Ile Gln Ile Arg Ser Val Ala Lys Lys His Pro Lys Thr Trp Val His 370 375 380 tac att gct gct gaa gag gag gac tgg gac tat gct ccc tta gtc ctc 1366 Tyr Ile Ala Ala Glu Glu Glu Asp Trp Asp Tyr Ala Pro Leu Val Leu 385 390 395 400 gcc ccc gat gac aga agt tat aaa agt caa tat ttg aac aat ggc cct 1414 Ala Pro Asp Asp Arg Ser Tyr Lys Ser Gln Tyr Leu Asn Asn Gly Pro 405 410 415 cag cgg att ggt agg aag tac aaa aaa gtc cga ttt atg gca tac aca 1462 Gln Arg Ile Gly Arg Lys Tyr Lys Lys Val Arg Phe Met Ala Tyr Thr 420 425 430 gat gaa acc ttt aag act cgt gaa gct att cag cat gaa tca gga atc 1510 Asp Glu Thr Phe Lys Thr Arg Glu Ala Ile Gln His Glu Ser Gly Ile 435 440 445 ttg gga cct tta ctt tat ggg gaa gtt gga gac aca ctg ttg att ata 1558 Leu Gly Pro Leu Leu Tyr Gly Glu Val Gly Asp Thr Leu Leu Ile Ile 450 455 460 ttt aag aat caa gca agc aga cca tat aac atc tac cct cac gga atc 1606 Phe Lys Asn Gln Ala Ser Arg Pro Tyr Asn Ile Tyr Pro His Gly Ile 465 470 475 480 act gat gtc cgt cct ttg tat tca agg aga tta cca aaa ggt gta aaa 1654 Thr Asp Val Arg Pro Leu Tyr Ser Arg Arg Leu Pro Lys Gly Val Lys 485 490 495 cat ttg aag gat ttt cca att ctg cca gga gaa ata ttc aaa tat aaa 1702 His Leu Lys Asp Phe Pro Ile Leu Pro Gly Glu Ile Phe Lys Tyr Lys 500 505 510 tgg aca gtg act gta gaa gat ggg cca act aaa tca gat cct cgg tgc 1750 Trp Thr Val Thr Val Glu Asp Gly Pro Thr Lys Ser Asp Pro Arg Cys 515 520 525 ctg acc cgc tat tac tct agt ttc gtt aat atg gag aga gat cta gct 1798 Leu Thr Arg Tyr Tyr Ser Ser Phe Val Asn Met Glu Arg Asp Leu Ala 530 535 540 tca gga ctc att ggc cct ctc ctc atc tgc tac aaa gaa tct gta gat 1846 Ser Gly Leu Ile Gly Pro Leu Leu Ile Cys Tyr Lys Glu Ser Val Asp 545 550 555 560 caa aga gga aac cag ata atg tca gac aag agg aat gtc atc ctg ttt 1894 Gln Arg Gly Asn Gln Ile Met Ser Asp Lys Arg Asn Val Ile Leu Phe 565 570 575 tct gta ttt gat gag aac cga agc tgg tac ctc aca gag aat ata caa 1942 Ser Val Phe Asp Glu Asn Arg Ser Trp Tyr Leu Thr Glu Asn Ile Gln 580 585 590 cgc ttt ctc ccc aat cca gct gga gtg cag ctt gag gat cca gag ttc 1990 Arg Phe Leu Pro Asn Pro Ala Gly Val Gln Leu Glu Asp Pro Glu Phe 595 600 605 caa gcc tcc aac atc atg cac agc atc aat ggc tat gtt ttt gat agt 2038 Gln Ala Ser Asn Ile Met His Ser Ile Asn Gly Tyr Val Phe Asp Ser 610 615 620 ttg cag ttg tca gtt tgt ttg cat gag gtg gca tac tgg tac att cta 2086 Leu Gln Leu Ser Val Cys Leu His Glu Val Ala Tyr Trp Tyr Ile Leu 625 630 635 640 agc att gga gca cag act gac ttc ctt tct gtc ttc ttc tct gga tat 2134 Ser Ile Gly Ala Gln Thr Asp Phe Leu Ser Val Phe Phe Ser Gly Tyr 645 650 655 acc ttc aaa cac aaa atg gtc tat gaa gac aca ctc acc cta ttc cca 2182 Thr Phe Lys His Lys Met Val Tyr Glu Asp Thr Leu Thr Leu Phe Pro 660 665 670 ttc tca gga gaa act gtc ttc atg tcg atg gaa aac cca ggt cta tgg 2230 Phe Ser Gly Glu Thr Val Phe Met Ser Met Glu Asn Pro Gly Leu Trp 675 680 685 att ctg ggg tgc cac aac tca gac ttt cgg aac aga ggc atg acc gcc 2278 Ile Leu Gly Cys His Asn Ser Asp Phe Arg Asn Arg Gly Met Thr Ala 690 695 700 tta ctg aag gtt tct agt tgt gac aag aac act ggt gat tat tac gag 2326 Leu Leu Lys Val Ser Ser Cys Asp Lys Asn Thr Gly Asp Tyr Tyr Glu 705 710 715 720 gac agt tat gaa gat att tca gca tac ttg ctg agt aaa aac aat gcc 2374 Asp Ser Tyr Glu Asp Ile Ser Ala Tyr Leu Leu Ser Lys Asn Asn Ala 725 730 735 att gaa cca aga agc ttc tcc cag aat tca aga cac cgt agc act agg 2422 Ile Glu Pro Arg Ser Phe Ser Gln Asn Ser Arg His Arg Ser Thr Arg 740 745 750 caa aag caa ttt aat gcc acc aca att cca gaa aat gac ata gag aag 2470 Gln Lys Gln Phe Asn Ala Thr Thr Ile Pro Glu Asn Asp Ile Glu Lys 755 760 765 act gac cct tgg ttt gca cac aga aca cct atg cct aaa ata caa aat 2518 Thr Asp Pro Trp Phe Ala His Arg Thr Pro Met Pro Lys Ile Gln Asn 770 775 780 gtc tcc tct agt gat ttg ttg atg ctc ttg cga cag agt cct act cca 2566 Val Ser Ser Ser Asp Leu Leu Met Leu Leu Arg Gln Ser Pro Thr Pro 785 790 795 800 cat ggg cta tcc tta tct gat ctc caa gaa gcc aaa tat gag act ttt 2614 His Gly Leu Ser Leu Ser Asp Leu Gln Glu Ala Lys Tyr Glu Thr Phe 805 810 815 tct gat gat cca tca cct gga gca ata gac agt aat aac agc ctg tct 2662 Ser Asp Asp Pro Ser Pro Gly Ala Ile Asp Ser Asn Asn Ser Leu Ser 820 825 830 gaa atg aca cac ttc agg cca cag ctc cat cac agt ggg gac atg gta 2710 Glu Met Thr His Phe Arg Pro Gln Leu His His Ser Gly Asp Met Val 835 840 845 ttt acc cct gag tca ggc ctc caa tta aga tta aat gag aaa ctg ggg 2758 Phe Thr Pro Glu Ser Gly Leu Gln Leu Arg Leu Asn Glu Lys Leu Gly 850 855 860 aca act gca gca aca gag ttg aag aaa ctt gat ttc aaa gtt tct agt 2806 Thr Thr Ala Ala Thr Glu Leu Lys Lys Leu Asp Phe Lys Val Ser Ser 865 870 875 880 aca tca aat aat ctg att tca aca att cca tca gac aat ttg gca gca 2854 Thr Ser Asn Asn Leu Ile Ser Thr Ile Pro Ser Asp Asn Leu Ala Ala 885 890 895 ggt act gat aat aca agt tcc tta gga ccc cca agt atg cca gtt cat 2902 Gly Thr Asp Asn Thr Ser Ser Leu Gly Pro Pro Ser Met Pro Val His 900 905 910 tat gat agt caa tta gat acc act cta ttt ggc aaa aag tca tct ccc 2950 Tyr Asp Ser Gln Leu Asp Thr Thr Leu Phe Gly Lys Lys Ser Ser Pro 915 920 925 ctt act gag tct ggt gga cct ctg agc ttg agt gaa gaa aat aat gat 2998 Leu Thr Glu Ser Gly Gly Pro Leu Ser Leu Ser Glu Glu Asn Asn Asp 930 935 940 tca aag ttg tta gaa tca ggt tta atg aat agc caa gaa agt tca tgg 3046 Ser Lys Leu Leu Glu Ser Gly Leu Met Asn Ser Gln Glu Ser Ser Trp 945 950 955 960 gga aaa aat gta tcg tca aca gag agt ggt agg tta ttt aaa ggg aaa 3094 Gly Lys Asn Val Ser Ser Thr Glu Ser Gly Arg Leu Phe Lys Gly Lys 965 970 975 aga gct cat gga cct gct ttg ttg act aaa gat aat gcc tta ttc aaa 3142 Arg Ala His Gly Pro Ala Leu Leu Thr Lys Asp Asn Ala Leu Phe Lys 980 985 990 gtt agc atc tct ttg tta aag aca aac aaa act tcc aat aat tca gca 3190 Val Ser Ile Ser Leu Leu Lys Thr Asn Lys Thr Ser Asn Asn Ser Ala 995 1000 1005 act aat aga aag act cac att gat ggc cca tca tta tta att gag 3235 Thr Asn Arg Lys Thr His Ile Asp Gly Pro Ser Leu Leu Ile Glu 1010 1015 1020 aat agt cca tca gtc tgg caa aat ata tta gaa agt gac act gag 3280 Asn Ser Pro Ser Val Trp Gln Asn Ile Leu Glu Ser Asp Thr Glu 1025 1030 1035 ttt aaa aaa gtg aca cct ttg att cat gac aga atg ctt atg gac 3325 Phe Lys Lys Val Thr Pro Leu Ile His Asp Arg Met Leu Met Asp 1040 1045 1050 aaa aat gct aca gct ttg agg cta aat cat atg tca aat aaa act 3370 Lys Asn Ala Thr Ala Leu Arg Leu Asn His Met Ser Asn Lys Thr 1055 1060 1065 act tca tca aaa aac atg gaa atg gtc caa cag aaa aaa gag ggc 3415 Thr Ser Ser Lys Asn Met Glu Met Val Gln Gln Lys Lys Glu Gly 1070 1075 1080 ccc att cca cca gat gca caa aat cca gat atg tcg ttc ttt aag 3460 Pro Ile Pro Pro Asp Ala Gln Asn Pro Asp Met Ser Phe Phe Lys 1085 1090 1095 atg cta ttc ttg cca gaa tca gca agg tgg ata caa agg act cat 3505 Met Leu Phe Leu Pro Glu Ser Ala Arg Trp Ile Gln Arg Thr His 1100 1105 1110 gga aag aac tct ctg aac tct ggg caa ggc ccc agt cca aag caa 3550 Gly Lys Asn Ser Leu Asn Ser Gly Gln Gly Pro Ser Pro Lys Gln 1115 1120 1125 tta gta tcc tta gga cca gaa aaa tct gtg gaa ggt cag aat ttc 3595 Leu Val Ser Leu Gly Pro Glu Lys Ser Val Glu Gly Gln Asn Phe 1130 1135 1140 ttg tct gag aaa aac aaa gtg gta gta gga aag ggt gaa ttt aca 3640 Leu Ser Glu Lys Asn Lys Val Val Val Gly Lys Gly Glu Phe Thr 1145 1150 1155 aag gac gta gga ctc aaa gag atg gtt ttt cca agc agc aga aac 3685 Lys Asp Val Gly Leu Lys Glu Met Val Phe Pro Ser Ser Arg Asn 1160 1165 1170 cta ttt ctt act aac ttg gat aat tta cat gaa aat aat aca cac 3730 Leu Phe Leu Thr Asn Leu Asp Asn Leu His Glu Asn Asn Thr His 1175 1180 1185 aat caa gaa aaa aaa att cag gaa gaa ata gaa aag aag gaa aca 3775 Asn Gln Glu Lys Lys Ile Gln Glu Glu Ile Glu Lys Lys Glu Thr 1190 1195 1200 tta atc caa gag aat gta gtt ttg cct cag ata cat aca gtg act 3820 Leu Ile Gln Glu Asn Val Val Leu Pro Gln Ile His Thr Val Thr 1205 1210 1215 ggc act aag aat ttc atg aag aac ctt ttc tta ctg agc act agg 3865 Gly Thr Lys Asn Phe Met Lys Asn Leu Phe Leu Leu Ser Thr Arg 1220 1225 1230 caa aat gta gaa ggt tca tat gac ggg gca tat gct cca gta ctt 3910 Gln Asn Val Glu Gly Ser Tyr Asp Gly Ala Tyr Ala Pro Val Leu 1235 1240 1245 caa gat ttt agg tca tta aat gat tca aca aat aga aca aag aaa 3955 Gln Asp Phe Arg Ser Leu Asn Asp Ser Thr Asn Arg Thr Lys Lys 1250 1255 1260 cac aca gct cat ttc tca aaa aaa ggg gag gaa gaa aac ttg gaa 4000 His Thr Ala His Phe Ser Lys Lys Gly Glu Glu Glu Asn Leu Glu 1265 1270 1275 ggc ttg gga aat caa acc aag caa att gta gag aaa tat gca tgc 4045 Gly Leu Gly Asn Gln Thr Lys Gln Ile Val Glu Lys Tyr Ala Cys 1280 1285 1290 acc aca agg ata tct cct aat aca agc cag cag aat ttt gtc acg 4090 Thr Thr Arg Ile Ser Pro Asn Thr Ser Gln Gln Asn Phe Val Thr 1295 1300 1305 caa cgt agt aag aga gct ttg aaa caa ttc aga ctc cca cta gaa 4135 Gln Arg Ser Lys Arg Ala Leu Lys Gln Phe Arg Leu Pro Leu Glu 1310 1315 1320 gaa aca gaa ctt gaa aaa agg ata att gtg gat gac acc tca acc 4180 Glu Thr Glu Leu Glu Lys Arg Ile Ile Val Asp Asp Thr Ser Thr 1325 1330 1335 cag tgg tcc aaa aac atg aaa cat ttg acc ccg agc acc ctc aca 4225 Gln Trp Ser Lys Asn Met Lys His Leu Thr Pro Ser Thr Leu Thr 1340 1345 1350 cag ata gac tac aat gag aag gag aaa ggg gcc att act cag tct 4270 Gln Ile Asp Tyr Asn Glu Lys Glu Lys Gly Ala Ile Thr Gln Ser 1355 1360 1365 ccc tta tca gat tgc ctt acg agg agt cat agc atc cct caa gca 4315 Pro Leu Ser Asp Cys Leu Thr Arg Ser His Ser Ile Pro Gln Ala 1370 1375 1380 aat aga tct cca tta ccc att gca aag gta tca tca ttt cca tct 4360 Asn Arg Ser Pro Leu Pro Ile Ala Lys Val Ser Ser Phe Pro Ser 1385 1390 1395 att aga cct ata tat ctg acc agg gtc cta ttc caa gac aac tct 4405 Ile Arg Pro Ile Tyr Leu Thr Arg Val Leu Phe Gln Asp Asn Ser 1400 1405 1410 tct cat ctt cca gca gca tct tat aga aag aaa gat tct ggg gtc 4450 Ser His Leu Pro Ala Ala Ser Tyr Arg Lys Lys Asp Ser Gly Val 1415 1420 1425 caa gaa agc agt cat ttc tta caa gga gcc aaa aaa aat aac ctt 4495 Gln Glu Ser Ser His Phe Leu Gln Gly Ala Lys Lys Asn Asn Leu 1430 1435 1440 tct tta gcc att cta acc ttg gag atg act ggt gat caa aga gag 4540 Ser Leu Ala Ile Leu Thr Leu Glu Met Thr Gly Asp Gln Arg Glu 1445 1450 1455 gtt ggc tcc ctg ggg aca agt gcc aca aat tca gtc aca tac aag 4585 Val Gly Ser Leu Gly Thr Ser Ala Thr Asn Ser Val Thr Tyr Lys 1460 1465 1470 aaa gtt gag aac act gtt ctc ccg aaa cca gac ttg ccc aaa aca 4630 Lys Val Glu Asn Thr Val Leu Pro Lys Pro Asp Leu Pro Lys Thr 1475 1480 1485 tct ggc aaa gtt gaa ttg ctt cca aaa gtt cac att tat cag aag 4675 Ser Gly Lys Val Glu Leu Leu Pro Lys Val His Ile Tyr Gln Lys 1490 1495 1500 gac cta ttc cct acg gaa act agc aat ggg tct cct ggc cat ctg 4720 Asp Leu Phe Pro Thr Glu Thr Ser Asn Gly Ser Pro Gly His Leu 1505 1510 1515 gat ctc gtg gaa ggg agc ctt ctt cag gga aca gag gga gcg att 4765 Asp Leu Val Glu Gly Ser Leu Leu Gln Gly Thr Glu Gly Ala Ile 1520 1525 1530 aag tgg aat gaa gca aac aga cct gga aaa gtt ccc ttt ctg aga 4810 Lys Trp Asn Glu Ala Asn Arg Pro Gly Lys Val Pro Phe Leu Arg 1535 1540 1545 gta gca aca gaa agc tct gca aag act ccc tcc aag cta ttg gat 4855 Val Ala Thr Glu Ser Ser Ala Lys Thr Pro Ser Lys Leu Leu Asp 1550 1555 1560 cct ctt gct tgg gat aac cac tat ggt act cag ata cca aaa gaa 4900 Pro Leu Ala Trp Asp Asn His Tyr Gly Thr Gln Ile Pro Lys Glu 1565 1570 1575 gag tgg aaa tcc caa gag aag tca cca gaa aaa aca gct ttt aag 4945 Glu Trp Lys Ser Gln Glu Lys Ser Pro Glu Lys Thr Ala Phe Lys 1580 1585 1590 aaa aag gat acc att ttg tcc ctg aac gct tgt gaa agc aat cat 4990 Lys Lys Asp Thr Ile Leu Ser Leu Asn Ala Cys Glu Ser Asn His 1595 1600 1605 gca ata gca gca ata aat gag gga caa aat aag ccc gaa ata gaa 5035 Ala Ile Ala Ala Ile Asn Glu Gly Gln Asn Lys Pro Glu Ile Glu 1610 1615 1620 gtc acc tgg gca aag caa ggt agg act gaa agg ctg tgc tct caa 5080 Val Thr Trp Ala Lys Gln Gly Arg Thr Glu Arg Leu Cys Ser Gln 1625 1630 1635 aac cca cca gtc ttg aaa cgc cat caa cgg gaa ata act cgt act 5125 Asn Pro Pro Val Leu Lys Arg His Gln Arg Glu Ile Thr Arg Thr 1640 1645 1650 act ctt cag tca gat caa gag gaa att gac tat gat gat acc ata 5170 Thr Leu Gln Ser Asp Gln Glu Glu Ile Asp Tyr Asp Asp Thr Ile 1655 1660 1665 tca gtt gaa atg aag aag gaa gat ttt gac att tat gat gag gat 5215 Ser Val Glu Met Lys Lys Glu Asp Phe Asp Ile Tyr Asp Glu Asp 1670 1675 1680 gaa aat cag agc ccc cgc agc ttt caa aag aaa aca cga cac tat 5260 Glu Asn Gln Ser Pro Arg Ser Phe Gln Lys Lys Thr Arg His Tyr 1685 1690 1695 ttt att gct gca gtg gag agg ctc tgg gat tat ggg atg agt agc 5305 Phe Ile Ala Ala Val Glu Arg Leu Trp Asp Tyr Gly Met Ser Ser 1700 1705 1710 tcc cca cat gtt cta aga aac agg gct cag agt ggc agt gtc cct 5350 Ser Pro His Val Leu Arg Asn Arg Ala Gln Ser Gly Ser Val Pro 1715 1720 1725 cag ttc aag aaa gtt gtt ttc cag gaa ttt act gat ggc tcc ttt 5395 Gln Phe Lys Lys Val Val Phe Gln Glu Phe Thr Asp Gly Ser Phe 1730 1735 1740 act cag ccc tta tac cgt gga gaa cta aat gaa cat ttg gga ctc 5440 Thr Gln Pro Leu Tyr Arg Gly Glu Leu Asn Glu His Leu Gly Leu 1745 1750 1755 ctg ggg cca tat ata aga gca gaa gtt gaa gat aat atc atg gta 5485 Leu Gly Pro Tyr Ile Arg Ala Glu Val Glu Asp Asn Ile Met Val 1760 1765 1770 act ttc aga aat cag gcc tct cgt ccc tat tcc ttc tat tct agc 5530 Thr Phe Arg Asn Gln Ala Ser Arg Pro Tyr Ser Phe Tyr Ser Ser 1775 1780 1785 ctt att tct tat gag gaa gat cag agg caa gga gca gaa cct aga 5575 Leu Ile Ser Tyr Glu Glu Asp Gln Arg Gln Gly Ala Glu Pro Arg 1790 1795 1800 aaa aac ttt gtc aag cct aat gaa acc aaa act tac ttt tgg aaa 5620 Lys Asn Phe Val Lys Pro Asn Glu Thr Lys Thr Tyr Phe Trp Lys 1805 1810 1815 gtg caa cat cat atg gca ccc act aaa gat gag ttt gac tgc aaa 5665 Val Gln His His Met Ala Pro Thr Lys Asp Glu Phe Asp Cys Lys 1820 1825 1830 gcc tgg gct tat ttc tct gat gtt gac ctg gaa aaa gat gtg cac 5710 Ala Trp Ala Tyr Phe Ser Asp Val Asp Leu Glu Lys Asp Val His 1835 1840 1845 tca ggc ctg att gga ccc ctt ctg gtc tgc cac act aac aca ctg 5755 Ser Gly Leu Ile Gly Pro Leu Leu Val Cys His Thr Asn Thr Leu 1850 1855 1860 aac cct gct cat ggg aga caa gtg aca gta cag gaa ttt gct ctg 5800 Asn Pro Ala His Gly Arg Gln Val Thr Val Gln Glu Phe Ala Leu 1865 1870 1875 ttt ttc acc atc ttt gat gag acc aaa agc tgg tac ttc act gaa 5845 Phe Phe Thr Ile Phe Asp Glu Thr Lys Ser Trp Tyr Phe Thr Glu 1880 1885 1890 aat atg gaa aga aac tgc agg gct ccc tgc aat atc cag atg gaa 5890 Asn Met Glu Arg Asn Cys Arg Ala Pro Cys Asn Ile Gln Met Glu 1895 1900 1905 gat ccc act ttt aaa gag aat tat cgc ttc cat gca atc aat ggc 5935 Asp Pro Thr Phe Lys Glu Asn Tyr Arg Phe His Ala Ile Asn Gly 1910 1915 1920 tac ata atg gat aca cta cct ggc tta gta atg gct cag gat caa 5980 Tyr Ile Met Asp Thr Leu Pro Gly Leu Val Met Ala Gln Asp Gln 1925 1930 1935 agg att cga tgg tat ctg ctc agc atg ggc agc aat gaa aac atc 6025 Arg Ile Arg Trp Tyr Leu Leu Ser Met Gly Ser Asn Glu Asn Ile 1940 1945 1950 cat tct att cat ttc agt gga cat gtg ttc act gta cga aaa aaa 6070 His Ser Ile His Phe Ser Gly His Val Phe Thr Val Arg Lys Lys 1955 1960 1965 gag gag tat aaa atg gca ctg tac aat ctc tat cca ggt gtt ttt 6115 Glu Glu Tyr Lys Met Ala Leu Tyr Asn Leu Tyr Pro Gly Val Phe 1970 1975 1980 gag aca gtg gaa atg tta cca tcc aaa gct gga att tgg cgg gtg 6160 Glu Thr Val Glu Met Leu Pro Ser Lys Ala Gly Ile Trp Arg Val 1985 1990 1995 gaa tgc ctt att ggc gag cat cta cat gct ggg atg agc aca ctt 6205 Glu Cys Leu Ile Gly Glu His Leu His Ala Gly Met Ser Thr Leu 2000 2005 2010 ttt ctg gtg tac agc aat aag tgt cag act ccc ctg gga atg gct 6250 Phe Leu Val Tyr Ser Asn Lys Cys Gln Thr Pro Leu Gly Met Ala 2015 2020 2025 tct gga cac att aga gat ttt cag att aca gct tca gga caa tat 6295 Ser Gly His Ile Arg Asp Phe Gln Ile Thr Ala Ser Gly Gln Tyr 2030 2035 2040 gga cag tgg gcc cca aag ctg gcc aga ctt cat tat tcc gga tca 6340 Gly Gln Trp Ala Pro Lys Leu Ala Arg Leu His Tyr Ser Gly Ser 2045 2050 2055 atc aat gcc tgg agc acc aag gag ccc ttt tct tgg atc aag gtg 6385 Ile Asn Ala Trp Ser Thr Lys Glu Pro Phe Ser Trp Ile Lys Val 2060 2065 2070 gat ctg ttg gca cca atg att att cac ggc atc aag acc cag ggt 6430 Asp Leu Leu Ala Pro Met Ile Ile His Gly Ile Lys Thr Gln Gly 2075 2080 2085 gcc cgt cag aag ttc tcc agc ctc tac atc tct cag ttt atc atc 6475 Ala Arg Gln Lys Phe Ser Ser Leu Tyr Ile Ser Gln Phe Ile Ile 2090 2095 2100 atg tat agt ctt gat ggg aag aag tgg cag act tat cga gga aat 6520 Met Tyr Ser Leu Asp Gly Lys Lys Trp Gln Thr Tyr Arg Gly Asn 2105 2110 2115 tcc act gga acc tta atg gtc ttc ttt ggc aat gtg gat tca tct 6565 Ser Thr Gly Thr Leu Met Val Phe Phe Gly Asn Val Asp Ser Ser 2120 2125 2130 ggg ata aaa cac aat att ttt aac cct cca att att gct cga tac 6610 Gly Ile Lys His Asn Ile Phe Asn Pro Pro Ile Ile Ala Arg Tyr 2135 2140 2145 atc cgt ttg cac cca act cat tat agc att cgc agc act ctt cgc 6655 Ile Arg Leu His Pro Thr His Tyr Ser Ile Arg Ser Thr Leu Arg 2150 2155 2160 atg gag ttg atg ggc tgt gat tta aat agt tgc agc atg cca ttg 6700 Met Glu Leu Met Gly Cys Asp Leu Asn Ser Cys Ser Met Pro Leu 2165 2170 2175 gga atg gag agt aaa gca ata tca gat gca cag att act gct tca 6745 Gly Met Glu Ser Lys Ala Ile Ser Asp Ala Gln Ile Thr Ala Ser 2180 2185 2190 tcc tac ttt acc aat atg ttt gcc acc tgg tct cct tca aaa gct 6790 Ser Tyr Phe Thr Asn Met Phe Ala Thr Trp Ser Pro Ser Lys Ala 2195 2200 2205 cga ctt cac ctc caa ggg agg agt aat gcc tgg aga cct cag gtg 6835 Arg Leu His Leu Gln Gly Arg Ser Asn Ala Trp Arg Pro Gln Val 2210 2215 2220 aat aat cca aaa gag tgg ctg caa gtg gac ttc cag aag aca atg 6880 Asn Asn Pro Lys Glu Trp Leu Gln Val Asp Phe Gln Lys Thr Met 2225 2230 2235 aaa gtc aca gga gta act act cag gga gta aaa tct ctg ctt acc 6925 Lys Val Thr Gly Val Thr Thr Gln Gly Val Lys Ser Leu Leu Thr 2240 2245 2250 agc atg tat gtg aag gag ttc ctc atc tcc agc agt caa gat ggc 6970 Ser Met Tyr Val Lys Glu Phe Leu Ile Ser Ser Ser Gln Asp Gly 2255 2260 2265 cat cag tgg act ctc ttt ttt cag aat ggc aaa gta aag gtt ttt 7015 His Gln Trp Thr Leu Phe Phe Gln Asn Gly Lys Val Lys Val Phe 2270 2275 2280 cag gga aat caa gac tcc ttc aca cct gtg gtg aac tct cta gac 7060 Gln Gly Asn Gln Asp Ser Phe Thr Pro Val Val Asn Ser Leu Asp 2285 2290 2295 cca ccg tta ctg act cgc tac ctt cga att cac ccc cag agt tgg 7105 Pro Pro Leu Leu Thr Arg Tyr Leu Arg Ile His Pro Gln Ser Trp 2300 2305 2310 gtg cac cag att gcc ctg agg atg gag gtt ctg ggc tgc gag gca 7150 Val His Gln Ile Ala Leu Arg Met Glu Val Leu Gly Cys Glu Ala 2315 2320 2325 cag gac ctc tac tgagggtggc cactgcagca cctgccactg ccgtcacctc 7202 Gln Asp Leu Tyr 2330 tccctcctca gctccagggc agtgtccctc cctggcttgc cttctacctt tgtgctaaat 7262 cctagcagac actgccttga agcctcctga attaactatc atcagtcctg catttctttg 7322 gtggggggcc aggagggtgc atccaattta acttaactct tacctatttt ctgcagctgc 7382 tcccagatta ctccttcctt ccaatataac taggcaaaaa gaagtgagga gaaacctgca 7442 tgaaagcatt cttccctgaa aagttaggcc tctcagagtc accacttcct ctgttgtaga 7502 aaaactatgt gatgaaactt tgaaaaagat atttatgatg ttaacatttc aggttaagcc 7562 tcatacgttt aaaataaaac tctcagttgt ttattatcct gatcaagcat ggaacaaagc 7622 atgtttcagg atcagatcaa tacaatcttg gagtcaaaag gcaaatcatt tggacaatct 7682 gcaaaatgga gagaatacaa taactactac agtaaagtct gtttctgctt ccttacacat 7742 agatataatt atgttattta gtcattatga ggggcacatt cttatctcca aaactagcat 7802 tcttaaactg agaattatag atggggttca agaatcccta agtcccctga aattatataa 7862 ggcattctgt ataaatgcaa atgtgcattt ttctgacgag tgtccataga tataaagcca 7922 tttggtctta attctgacca ataaaaaaat aagtcaggag gatgcaattg ttgaaagctt 7982 tgaaataaaa taacaatgtc ttcttgaaat ttgtgatggc caagaaagaa aatgatgatg 8042 acattaggct tctaaaggac atacatttaa tatttctgtg gaaatatgag gaaaatccat 8102 ggttatctga gataggagat acaaactttg taattctaat aatgcactca gtttactctc 8162 tccctctact aatttcctgc tgaaaataac acaacaaaaa tgtaacaggg gaaattatat 8222 accgtgactg aaaactagag tcctacttac atagttgaaa tatcaaggag gtcagaagaa 8282 aattggactg gtgaaaacag aaaaaacact ccagtctgcc atatcaccac acaataggat 8342 cccccttctt gccctccacc cccataagat tgtgaagggt ttactgctcc ttccatctgc 8402 ctgacccctt cactatgact acacagaatc tcctgatagt aaagggggct ggaggcaagg 8462 ataagttata gagcagttgg aggaagcatc caaagattgc aacccagggc aaatggaaaa 8522 caggagatcc taatatgaaa gaaaaatgga tcccaatctg agaaaaggca aaagaatggc 8582 tacttttttc tatgctggag tattttctaa taatcctgct tgacccttat ctgacctctt 8642 tggaaactat aacatagctg tcacagtata gtcacaatcc acaaatgatg caggtgcaaa 8702 tggtttatag ccctgtgaag ttcttaaagt ttagaggcta acttacagaa atgaataagt 8762 tgttttgttt tatagcccgg tagaggagtt aaccccaaag gtgatatggt tttatttcct 8822 gttatgttta acttgataat cttattttgg cattcttttc ccattgacta tatacatctc 8882 tatttctcaa atgttcatgg aactagctct tttattttcc tgctggtttc ttcagtaatg 8942 agttaaataa aacattgaca catac 8967 2 2351 PRT Homo sapiens 2 Met Gln Ile Glu Leu Ser Thr Cys Phe Phe Leu Cys Leu Leu Arg Phe -15 -10 -5 Cys Phe Ser Ala Thr Arg Arg Tyr Tyr Leu Gly Ala Val Glu Leu Ser -1 1 5 10 Trp Asp Tyr Met Gln Ser Asp Leu Gly Glu Leu Pro Val Asp Ala Arg 15 20 25 Phe Pro Pro Arg Val Pro Lys Ser Phe Pro Phe Asn Thr Ser Val Val 30 35 40 45 Tyr Lys Lys Thr Leu Phe Val Glu Phe Thr Asp His Leu Phe Asn Ile 50 55 60 Ala Lys Pro Arg Pro Pro Trp Met Gly Leu Leu Gly Pro Thr Ile Gln 65 70 75 Ala Glu Val Tyr Asp Thr Val Val Ile Thr Leu Lys Asn Met Ala Ser 80 85 90 His Pro Val Ser Leu His Ala Val Gly Val Ser Tyr Trp Lys Ala Ser 95 100 105 Glu Gly Ala Glu Tyr Asp Asp Gln Thr Ser Gln Arg Glu Lys Glu Asp 110 115 120 125 Asp Lys Val Phe Pro Gly Gly Ser His Thr Tyr Val Trp Gln Val Leu 130 135 140 Lys Glu Asn Gly Pro Met Ala Ser Asp Pro Leu Cys Leu Thr Tyr Ser 145 150 155 Tyr Leu Ser His Val Asp Leu Val Lys Asp Leu Asn Ser Gly Leu Ile 160 165 170 Gly Ala Leu Leu Val Cys Arg Glu Gly Ser Leu Ala Lys Glu Lys Thr 175 180 185 Gln Thr Leu His Lys Phe Ile Leu Leu Phe Ala Val Phe Asp Glu Gly 190 195 200 205 Lys Ser Trp His Ser Glu Thr Lys Asn Ser Leu Met Gln Asp Arg Asp 210 215 220 Ala Ala Ser Ala Arg Ala Trp Pro Lys Met His Thr Val Asn Gly Tyr 225 230 235 Val Asn Arg Ser Leu Pro Gly Leu Ile Gly Cys His Arg Lys Ser Val 240 245 250 Tyr Trp His Val Ile Gly Met Gly Thr Thr Pro Glu Val His Ser Ile 255 260 265 Phe Leu Glu Gly His Thr Phe Leu Val Arg Asn His Arg Gln Ala Ser 270 275 280 285 Leu Glu Ile Ser Pro Ile Thr Phe Leu Thr Ala Gln Thr Leu Leu Met 290 295 300 Asp Leu Gly Gln Phe Leu Leu Phe Cys His Ile Ser Ser His Gln His 305 310 315 Asp Gly Met Glu Ala Tyr Val Lys Val Asp Ser Cys Pro Glu Glu Pro 320 325 330 Gln Leu Arg Met Lys Asn Asn Glu Glu Ala Glu Asp Tyr Asp Asp Asp 335 340 345 Leu Thr Asp Ser Glu Met Asp Val Val Arg Phe Asp Asp Asp Asn Ser 350 355 360 365 Pro Ser Phe Ile Gln Ile Arg Ser Val Ala Lys Lys His Pro Lys Thr 370 375 380 Trp Val His Tyr Ile Ala Ala Glu Glu Glu Asp Trp Asp Tyr Ala Pro 385 390 395 Leu Val Leu Ala Pro Asp Asp Arg Ser Tyr Lys Ser Gln Tyr Leu Asn 400 405 410 Asn Gly Pro Gln Arg Ile Gly Arg Lys Tyr Lys Lys Val Arg Phe Met 415 420 425 Ala Tyr Thr Asp Glu Thr Phe Lys Thr Arg Glu Ala Ile Gln His Glu 430 435 440 445 Ser Gly Ile Leu Gly Pro Leu Leu Tyr Gly Glu Val Gly Asp Thr Leu 450 455 460 Leu Ile Ile Phe Lys Asn Gln Ala Ser Arg Pro Tyr Asn Ile Tyr Pro 465 470 475 His Gly Ile Thr Asp Val Arg Pro Leu Tyr Ser Arg Arg Leu Pro Lys 480 485 490 Gly Val Lys His Leu Lys Asp Phe Pro Ile Leu Pro Gly Glu Ile Phe 495 500 505 Lys Tyr Lys Trp Thr Val Thr Val Glu Asp Gly Pro Thr Lys Ser Asp 510 515 520 525 Pro Arg Cys Leu Thr Arg Tyr Tyr Ser Ser Phe Val Asn Met Glu Arg 530 535 540 Asp Leu Ala Ser Gly Leu Ile Gly Pro Leu Leu Ile Cys Tyr Lys Glu 545 550 555 Ser Val Asp Gln Arg Gly Asn Gln Ile Met Ser Asp Lys Arg Asn Val 560 565 570 Ile Leu Phe Ser Val Phe Asp Glu Asn Arg Ser Trp Tyr Leu Thr Glu 575 580 585 Asn Ile Gln Arg Phe Leu Pro Asn Pro Ala Gly Val Gln Leu Glu Asp 590 595 600 605 Pro Glu Phe Gln Ala Ser Asn Ile Met His Ser Ile Asn Gly Tyr Val 610 615 620 Phe Asp Ser Leu Gln Leu Ser Val Cys Leu His Glu Val Ala Tyr Trp 625 630 635 Tyr Ile Leu Ser Ile Gly Ala Gln Thr Asp Phe Leu Ser Val Phe Phe 640 645 650 Ser Gly Tyr Thr Phe Lys His Lys Met Val Tyr Glu Asp Thr Leu Thr 655 660 665 Leu Phe Pro Phe Ser Gly Glu Thr Val Phe Met Ser Met Glu Asn Pro 670 675 680 685 Gly Leu Trp Ile Leu Gly Cys His Asn Ser Asp Phe Arg Asn Arg Gly 690 695 700 Met Thr Ala Leu Leu Lys Val Ser Ser Cys Asp Lys Asn Thr Gly Asp 705 710 715 Tyr Tyr Glu Asp Ser Tyr Glu Asp Ile Ser Ala Tyr Leu Leu Ser Lys 720 725 730 Asn Asn Ala Ile Glu Pro Arg Ser Phe Ser Gln Asn Ser Arg His Arg 735 740 745 Ser Thr Arg Gln Lys Gln Phe Asn Ala Thr Thr Ile Pro Glu Asn Asp 750 755 760 765 Ile Glu Lys Thr Asp Pro Trp Phe Ala His Arg Thr Pro Met Pro Lys 770 775 780 Ile Gln Asn Val Ser Ser Ser Asp Leu Leu Met Leu Leu Arg Gln Ser 785 790 795 Pro Thr Pro His Gly Leu Ser Leu Ser Asp Leu Gln Glu Ala Lys Tyr 800 805 810 Glu Thr Phe Ser Asp Asp Pro Ser Pro Gly Ala Ile Asp Ser Asn Asn 815 820 825 Ser Leu Ser Glu Met Thr His Phe Arg Pro Gln Leu His His Ser Gly 830 835 840 845 Asp Met Val Phe Thr Pro Glu Ser Gly Leu Gln Leu Arg Leu Asn Glu 850 855 860 Lys Leu Gly Thr Thr Ala Ala Thr Glu Leu Lys Lys Leu Asp Phe Lys 865 870 875 Val Ser Ser Thr Ser Asn Asn Leu Ile Ser Thr Ile Pro Ser Asp Asn 880 885 890 Leu Ala Ala Gly Thr Asp Asn Thr Ser Ser Leu Gly Pro Pro Ser Met 895 900 905 Pro Val His Tyr Asp Ser Gln Leu Asp Thr Thr Leu Phe Gly Lys Lys 910 915 920 925 Ser Ser Pro Leu Thr Glu Ser Gly Gly Pro Leu Ser Leu Ser Glu Glu 930 935 940 Asn Asn Asp Ser Lys Leu Leu Glu Ser Gly Leu Met Asn Ser Gln Glu 945 950 955 Ser Ser Trp Gly Lys Asn Val Ser Ser Thr Glu Ser Gly Arg Leu Phe 960 965 970 Lys Gly Lys Arg Ala His Gly Pro Ala Leu Leu Thr Lys Asp Asn Ala 975 980 985 Leu Phe Lys Val Ser Ile Ser Leu Leu Lys Thr Asn Lys Thr Ser Asn 990 995 1000 1005 Asn Ser Ala Thr Asn Arg Lys Thr His Ile Asp Gly Pro Ser Leu 1010 1015 1020 Leu Ile Glu Asn Ser Pro Ser Val Trp Gln Asn Ile Leu Glu Ser 1025 1030 1035 Asp Thr Glu Phe Lys Lys Val Thr Pro Leu Ile His Asp Arg Met 1040 1045 1050 Leu Met Asp Lys Asn Ala Thr Ala Leu Arg Leu Asn His Met Ser 1055 1060 1065 Asn Lys Thr Thr Ser Ser Lys Asn Met Glu Met Val Gln Gln Lys 1070 1075 1080 Lys Glu Gly Pro Ile Pro Pro Asp Ala Gln Asn Pro Asp Met Ser 1085 1090 1095 Phe Phe Lys Met Leu Phe Leu Pro Glu Ser Ala Arg Trp Ile Gln 1100 1105 1110 Arg Thr His Gly Lys Asn Ser Leu Asn Ser Gly Gln Gly Pro Ser 1115 1120 1125 Pro Lys Gln Leu Val Ser Leu Gly Pro Glu Lys Ser Val Glu Gly 1130 1135 1140 Gln Asn Phe Leu Ser Glu Lys Asn Lys Val Val Val Gly Lys Gly 1145 1150 1155 Glu Phe Thr Lys Asp Val Gly Leu Lys Glu Met Val Phe Pro Ser 1160 1165 1170 Ser Arg Asn Leu Phe Leu Thr Asn Leu Asp Asn Leu His Glu Asn 1175 1180 1185 Asn Thr His Asn Gln Glu Lys Lys Ile Gln Glu Glu Ile Glu Lys 1190 1195 1200 Lys Glu Thr Leu Ile Gln Glu Asn Val Val Leu Pro Gln Ile His 1205 1210 1215 Thr Val Thr Gly Thr Lys Asn Phe Met Lys Asn Leu Phe Leu Leu 1220 1225 1230 Ser Thr Arg Gln Asn Val Glu Gly Ser Tyr Asp Gly Ala Tyr Ala 1235 1240 1245 Pro Val Leu Gln Asp Phe Arg Ser Leu Asn Asp Ser Thr Asn Arg 1250 1255 1260 Thr Lys Lys His Thr Ala His Phe Ser Lys Lys Gly Glu Glu Glu 1265 1270 1275 Asn Leu Glu Gly Leu Gly Asn Gln Thr Lys Gln Ile Val Glu Lys 1280 1285 1290 Tyr Ala Cys Thr Thr Arg Ile Ser Pro Asn Thr Ser Gln Gln Asn 1295 1300 1305 Phe Val Thr Gln Arg Ser Lys Arg Ala Leu Lys Gln Phe Arg Leu 1310 1315 1320 Pro Leu Glu Glu Thr Glu Leu Glu Lys Arg Ile Ile Val Asp Asp 1325 1330 1335 Thr Ser Thr Gln Trp Ser Lys Asn Met Lys His Leu Thr Pro Ser 1340 1345 1350 Thr Leu Thr Gln Ile Asp Tyr Asn Glu Lys Glu Lys Gly Ala Ile 1355 1360 1365 Thr Gln Ser Pro Leu Ser Asp Cys Leu Thr Arg Ser His Ser Ile 1370 1375 1380 Pro Gln Ala Asn Arg Ser Pro Leu Pro Ile Ala Lys Val Ser Ser 1385 1390 1395 Phe Pro Ser Ile Arg Pro Ile Tyr Leu Thr Arg Val Leu Phe Gln 1400 1405 1410 Asp Asn Ser Ser His Leu Pro Ala Ala Ser Tyr Arg Lys Lys Asp 1415 1420 1425 Ser Gly Val Gln Glu Ser Ser His Phe Leu Gln Gly Ala Lys Lys 1430 1435 1440 Asn Asn Leu Ser Leu Ala Ile Leu Thr Leu Glu Met Thr Gly Asp 1445 1450 1455 Gln Arg Glu Val Gly Ser Leu Gly Thr Ser Ala Thr Asn Ser Val 1460 1465 1470 Thr Tyr Lys Lys Val Glu Asn Thr Val Leu Pro Lys Pro Asp Leu 1475 1480 1485 Pro Lys Thr Ser Gly Lys Val Glu Leu Leu Pro Lys Val His Ile 1490 1495 1500 Tyr Gln Lys Asp Leu Phe Pro Thr Glu Thr Ser Asn Gly Ser Pro 1505 1510 1515 Gly His Leu Asp Leu Val Glu Gly Ser Leu Leu Gln Gly Thr Glu 1520 1525 1530 Gly Ala Ile Lys Trp Asn Glu Ala Asn Arg Pro Gly Lys Val Pro 1535 1540 1545 Phe Leu Arg Val Ala Thr Glu Ser Ser Ala Lys Thr Pro Ser Lys 1550 1555 1560 Leu Leu Asp Pro Leu Ala Trp Asp Asn His Tyr Gly Thr Gln Ile 1565 1570 1575 Pro Lys Glu Glu Trp Lys Ser Gln Glu Lys Ser Pro Glu Lys Thr 1580 1585 1590 Ala Phe Lys Lys Lys Asp Thr Ile Leu Ser Leu Asn Ala Cys Glu 1595 1600 1605 Ser Asn His Ala Ile Ala Ala Ile Asn Glu Gly Gln Asn Lys Pro 1610 1615 1620 Glu Ile Glu Val Thr Trp Ala Lys Gln Gly Arg Thr Glu Arg Leu 1625 1630 1635 Cys Ser Gln Asn Pro Pro Val Leu Lys Arg His Gln Arg Glu Ile 1640 1645 1650 Thr Arg Thr Thr Leu Gln Ser Asp Gln Glu Glu Ile Asp Tyr Asp 1655 1660 1665 Asp Thr Ile Ser Val Glu Met Lys Lys Glu Asp Phe Asp Ile Tyr 1670 1675 1680 Asp Glu Asp Glu Asn Gln Ser Pro Arg Ser Phe Gln Lys Lys Thr 1685 1690 1695 Arg His Tyr Phe Ile Ala Ala Val Glu Arg Leu Trp Asp Tyr Gly 1700 1705 1710 Met Ser Ser Ser Pro His Val Leu Arg Asn Arg Ala Gln Ser Gly 1715 1720 1725 Ser Val Pro Gln Phe Lys Lys Val Val Phe Gln Glu Phe Thr Asp 1730 1735 1740 Gly Ser Phe Thr Gln Pro Leu Tyr Arg Gly Glu Leu Asn Glu His 1745 1750 1755 Leu Gly Leu Leu Gly Pro Tyr Ile Arg Ala Glu Val Glu Asp Asn 1760 1765 1770 Ile Met Val Thr Phe Arg Asn Gln Ala Ser Arg Pro Tyr Ser Phe 1775 1780 1785 Tyr Ser Ser Leu Ile Ser Tyr Glu Glu Asp Gln Arg Gln Gly Ala 1790 1795 1800 Glu Pro Arg Lys Asn Phe Val Lys Pro Asn Glu Thr Lys Thr Tyr 1805 1810 1815 Phe Trp Lys Val Gln His His Met Ala Pro Thr Lys Asp Glu Phe 1820 1825 1830 Asp Cys Lys Ala Trp Ala Tyr Phe Ser Asp Val Asp Leu Glu Lys 1835 1840 1845 Asp Val His Ser Gly Leu Ile Gly Pro Leu Leu Val Cys His Thr 1850 1855 1860 Asn Thr Leu Asn Pro Ala His Gly Arg Gln Val Thr Val Gln Glu 1865 1870 1875 Phe Ala Leu Phe Phe Thr Ile Phe Asp Glu Thr Lys Ser Trp Tyr 1880 1885 1890 Phe Thr Glu Asn Met Glu Arg Asn Cys Arg Ala Pro Cys Asn Ile 1895 1900 1905 Gln Met Glu Asp Pro Thr Phe Lys Glu Asn Tyr Arg Phe His Ala 1910 1915 1920 Ile Asn Gly Tyr Ile Met Asp Thr Leu Pro Gly Leu Val Met Ala 1925 1930 1935 Gln Asp Gln Arg Ile Arg Trp Tyr Leu Leu Ser Met Gly Ser Asn 1940 1945 1950 Glu Asn Ile His Ser Ile His Phe Ser Gly His Val Phe Thr Val 1955 1960 1965 Arg Lys Lys Glu Glu Tyr Lys Met Ala Leu Tyr Asn Leu Tyr Pro 1970 1975 1980 Gly Val Phe Glu Thr Val Glu Met Leu Pro Ser Lys Ala Gly Ile 1985 1990 1995 Trp Arg Val Glu Cys Leu Ile Gly Glu His Leu His Ala Gly Met 2000 2005 2010 Ser Thr Leu Phe Leu Val Tyr Ser Asn Lys Cys Gln Thr Pro Leu 2015 2020 2025 Gly Met Ala Ser Gly His Ile Arg Asp Phe Gln Ile Thr Ala Ser 2030 2035 2040 Gly Gln Tyr Gly Gln Trp Ala Pro Lys Leu Ala Arg Leu His Tyr 2045 2050 2055 Ser Gly Ser Ile Asn Ala Trp Ser Thr Lys Glu Pro Phe Ser Trp 2060 2065 2070 Ile Lys Val Asp Leu Leu Ala Pro Met Ile Ile His Gly Ile Lys 2075 2080 2085 Thr Gln Gly Ala Arg Gln Lys Phe Ser Ser Leu Tyr Ile Ser Gln 2090 2095 2100 Phe Ile Ile Met Tyr Ser Leu Asp Gly Lys Lys Trp Gln Thr Tyr 2105 2110 2115 Arg Gly Asn Ser Thr Gly Thr Leu Met Val Phe Phe Gly Asn Val 2120 2125 2130 Asp Ser Ser Gly Ile Lys His Asn Ile Phe Asn Pro Pro Ile Ile 2135 2140 2145 Ala Arg Tyr Ile Arg Leu His Pro Thr His Tyr Ser Ile Arg Ser 2150 2155 2160 Thr Leu Arg Met Glu Leu Met Gly Cys Asp Leu Asn Ser Cys Ser 2165 2170 2175 Met Pro Leu Gly Met Glu Ser Lys Ala Ile Ser Asp Ala Gln Ile 2180 2185 2190 Thr Ala Ser Ser Tyr Phe Thr Asn Met Phe Ala Thr Trp Ser Pro 2195 2200 2205 Ser Lys Ala Arg Leu His Leu Gln Gly Arg Ser Asn Ala Trp Arg 2210 2215 2220 Pro Gln Val Asn Asn Pro Lys Glu Trp Leu Gln Val Asp Phe Gln 2225 2230 2235 Lys Thr Met Lys Val Thr Gly Val Thr Thr Gln Gly Val Lys Ser 2240 2245 2250 Leu Leu Thr Ser Met Tyr Val Lys Glu Phe Leu Ile Ser Ser Ser 2255 2260 2265 Gln Asp Gly His Gln Trp Thr Leu Phe Phe Gln Asn Gly Lys Val 2270 2275 2280 Lys Val Phe Gln Gly Asn Gln Asp Ser Phe Thr Pro Val Val Asn 2285 2290 2295 Ser Leu Asp Pro Pro Leu Leu Thr Arg Tyr Leu Arg Ile His Pro 2300 2305 2310 Gln Ser Trp Val His Gln Ile Ala Leu Arg Met Glu Val Leu Gly 2315 2320 2325 Cys Glu Ala Gln Asp Leu Tyr 2330 3 1493 DNA Homo sapiens sig_peptide (14)..(115) mat_peptide (116)..(1084) CDS (14)..(1084) 3 tgagcggggg atg atg gcg ccg cgg agg gtc agg tcg ttt ctg cgc ggg 49 Met Ala Pro Arg Arg Val Arg Ser Phe Leu Arg Gly -30 -25 ctc ccg gcg ctg cta ctg ctg ctg ctc ttc ctc ggg ccc tgg ccc gct 97 Leu Pro Ala Leu Leu Leu Leu Leu Leu Phe Leu Gly Pro Trp Pro Ala -20 -15 -10 gcg agc cac ggc ggc aag tac tcg cgg gag aag aac cag ccc aag ccg 145 Ala Ser His Gly Gly Lys Tyr Ser Arg Glu Lys Asn Gln Pro Lys Pro -5 -1 1 5 10 tcc ccg aaa cgc gag tcc gga gag gag ttc cgc atg gag aag ttg aac 193 Ser Pro Lys Arg Glu Ser Gly Glu Glu Phe Arg Met Glu Lys Leu Asn 15 20 25 cag ctg tgg gag aag gcc cag cga ctg cat ctt cct ccc gtg agg ctg 241 Gln Leu Trp Glu Lys Ala Gln Arg Leu His Leu Pro Pro Val Arg Leu 30 35 40 gcc gag ctc cac gct gat ctg aag ata cag gag agg gac gaa ctc gcc 289 Ala Glu Leu His Ala Asp Leu Lys Ile Gln Glu Arg Asp Glu Leu Ala 45 50 55 tgg aag aaa cta aag ctt gac ggc ttg gac gaa gat ggg gag aag gaa 337 Trp Lys Lys Leu Lys Leu Asp Gly Leu Asp Glu Asp Gly Glu Lys Glu 60 65 70 gcg aga ctc ata cgc aac ctc aat gtc atc ttg gcc aag tat ggt ctg 385 Ala Arg Leu Ile Arg Asn Leu Asn Val Ile Leu Ala Lys Tyr Gly Leu 75 80 85 90 gac gga aag aag gac gct cgg cag gtg acc agc aac tcc ctc agt ggc 433 Asp Gly Lys Lys Asp Ala Arg Gln Val Thr Ser Asn Ser Leu Ser Gly 95 100 105 acc cag gaa gac ggg ctg gat gac ccc agg ctg gaa aag ctg tgg cac 481 Thr Gln Glu Asp Gly Leu Asp Asp Pro Arg Leu Glu Lys Leu Trp His 110 115 120 aag gcg aag acc tct ggg aaa ttc tcc ggc gaa gaa ctg gac aag ctc 529 Lys Ala Lys Thr Ser Gly Lys Phe Ser Gly Glu Glu Leu Asp Lys Leu 125 130 135 tgg cgg gag ttc ctg cat cac aaa gag aaa gtt cac gag tac aac gtc 577 Trp Arg Glu Phe Leu His His Lys Glu Lys Val His Glu Tyr Asn Val 140 145 150 ctg ctg gag acc ctg agc agg acc gaa gaa atc cac gag aac gtc att 625 Leu Leu Glu Thr Leu Ser Arg Thr Glu Glu Ile His Glu Asn Val Ile 155 160 165 170 agc ccc tcg gac ctg agc gac atc aag ggc agc gtc ctg cac agc agg 673 Ser Pro Ser Asp Leu Ser Asp Ile Lys Gly Ser Val Leu His Ser Arg 175 180 185 cac acg gag ctg aag gag aag ctg cgc agc atc aac cag ggc ctg gac 721 His Thr Glu Leu Lys Glu Lys Leu Arg Ser Ile Asn Gln Gly Leu Asp 190 195 200 cgc ctg cgc agg gtc agc cac cag ggc tac agc act gag gct gag ttc 769 Arg Leu Arg Arg Val Ser His Gln Gly Tyr Ser Thr Glu Ala Glu Phe 205 210 215 gag gag ccc agg gtg att gac ctg tgg gac ctg gcg cag tcc gcc aac 817 Glu Glu Pro Arg Val Ile Asp Leu Trp Asp Leu Ala Gln Ser Ala Asn 220 225 230 ctc acg gac aag gag ctg gag gcg ttc cgg gag gag ctc aag cac ttc 865 Leu Thr Asp Lys Glu Leu Glu Ala Phe Arg Glu Glu Leu Lys His Phe 235 240 245 250 gaa gcc aaa atc gag aag cac aac cac tac cag aag cag ctg gag att 913 Glu Ala Lys Ile Glu Lys His Asn His Tyr Gln Lys Gln Leu Glu Ile 255 260 265 gcg cac gag aag ctg agg cac gca gag agc gtg ggc gac ggc gag cgt 961 Ala His Glu Lys Leu Arg His Ala Glu Ser Val Gly Asp Gly Glu Arg 270 275 280 gtg agc cgc agc cgc gag aag cac gcc ctg ctg gag ggg cgg acc aag 1009 Val Ser Arg Ser Arg Glu Lys His Ala Leu Leu Glu Gly Arg Thr Lys 285 290 295 gag ctg ggc tac acg gtg aag aag cat ctg cag gac ctg tcc ggc agg 1057 Glu Leu Gly Tyr Thr Val Lys Lys His Leu Gln Asp Leu Ser Gly Arg 300 305 310 atc tcc aga gct cgg cac aac gaa ctc tgaaggcact ggggagccca 1104 Ile Ser Arg Ala Arg His Asn Glu Leu 315 320 gcccggcagg gaagaggcca gcgtgaagga cctgggctct tggccgtggc atttccgtgg 1164 acagcccgcc gtcagggtgg ctggggctgg cacgggtgtc gaggcaggaa ggattgtttc 1224 tggtgactgc agccgctgcc gtcgcgacac agggcttggt ggtggtagca tttgggtctg 1284 agatcggccc agctctgact gaaggggctt ggcttccact cagcatcagc gtggcagtca 1344 ccaccccagt gaggacctcg atgtccagct gctgtcaggt ctgatagtcc tctgctaaaa 1404 caacacgatt tacataaaaa atcttacaca tctgccaccg gaaataccat gcacagagtc 1464 cttaaaaaat agagtgcagt atttaaacc 1493 4 357 PRT Homo sapiens 4 Met Ala Pro Arg Arg Val Arg Ser Phe Leu Arg Gly Leu Pro Ala Leu -30 -25 -20 Leu Leu Leu Leu Leu Phe Leu Gly Pro Trp Pro Ala Ala Ser His Gly -15 -10 -5 Gly Lys Tyr Ser Arg Glu Lys Asn Gln Pro Lys Pro Ser Pro Lys Arg -1 1 5 10 Glu Ser Gly Glu Glu Phe Arg Met Glu Lys Leu Asn Gln Leu Trp Glu 15 20 25 30 Lys Ala Gln Arg Leu His Leu Pro Pro Val Arg Leu Ala Glu Leu His 35 40 45 Ala Asp Leu Lys Ile Gln Glu Arg Asp Glu Leu Ala Trp Lys Lys Leu 50 55 60 Lys Leu Asp Gly Leu Asp Glu Asp Gly Glu Lys Glu Ala Arg Leu Ile 65 70 75 Arg Asn Leu Asn Val Ile Leu Ala Lys Tyr Gly Leu Asp Gly Lys Lys 80 85 90 Asp Ala Arg Gln Val Thr Ser Asn Ser Leu Ser Gly Thr Gln Glu Asp 95 100 105 110 Gly Leu Asp Asp Pro Arg Leu Glu Lys Leu Trp His Lys Ala Lys Thr 115 120 125 Ser Gly Lys Phe Ser Gly Glu Glu Leu Asp Lys Leu Trp Arg Glu Phe 130 135 140 Leu His His Lys Glu Lys Val His Glu Tyr Asn Val Leu Leu Glu Thr 145 150 155 Leu Ser Arg Thr Glu Glu Ile His Glu Asn Val Ile Ser Pro Ser Asp 160 165 170 Leu Ser Asp Ile Lys Gly Ser Val Leu His Ser Arg His Thr Glu Leu 175 180 185 190 Lys Glu Lys Leu Arg Ser Ile Asn Gln Gly Leu Asp Arg Leu Arg Arg 195 200 205 Val Ser His Gln Gly Tyr Ser Thr Glu Ala Glu Phe Glu Glu Pro Arg 210 215 220 Val Ile Asp Leu Trp Asp Leu Ala Gln Ser Ala Asn Leu Thr Asp Lys 225 230 235 Glu Leu Glu Ala Phe Arg Glu Glu Leu Lys His Phe Glu Ala Lys Ile 240 245 250 Glu Lys His Asn His Tyr Gln Lys Gln Leu Glu Ile Ala His Glu Lys 255 260 265 270 Leu Arg His Ala Glu Ser Val Gly Asp Gly Glu Arg Val Ser Arg Ser 275 280 285 Arg Glu Lys His Ala Leu Leu Glu Gly Arg Thr Lys Glu Leu Gly Tyr 290 295 300 Thr Val Lys Lys His Leu Gln Asp Leu Ser Gly Arg Ile Ser Arg Ala 305 310 315 Arg His Asn Glu Leu 320 5 1424 PRT Homo sapiens 5 Ala Thr Arg Arg Tyr Tyr Leu Gly Ala Val Glu Leu Ser Trp Asp Tyr 1 5 10 15 Met Gln Ser Asp Leu Gly Glu Leu Pro Val Asp Ala Arg Phe Pro Pro 20 25 30 Arg Val Pro Lys Ser Phe Pro Phe Asn Thr Ser Val Val Tyr Lys Lys 35 40 45 Thr Leu Phe Val Glu Phe Thr Asp His Leu Phe Asn Ile Ala Lys Pro 50 55 60 Arg Pro Pro Trp Met Gly Leu Leu Gly Pro Thr Ile Gln Ala Glu Val 65 70 75 80 Tyr Asp Thr Val Val Ile Thr Leu Lys Asn Met Ala Ser His Pro Val 85 90 95 Ser Leu His Ala Val Gly Val Ser Tyr Trp Lys Ala Ser Glu Gly Ala 100 105 110 Glu Tyr Asp Asp Gln Thr Ser Gln Arg Glu Lys Glu Asp Asp Lys Val 115 120 125 Phe Pro Gly Gly Ser His Thr Tyr Val Trp Gln Val Leu Lys Glu Asn 130 135 140 Gly Pro Met Ala Ser Asp Pro Leu Cys Leu Thr Tyr Ser Tyr Leu Ser 145 150 155 160 His Val Asp Leu Val Lys Asp Leu Asn Ser Gly Leu Ile Gly Ala Leu 165 170 175 Leu Val Cys Arg Glu Gly Ser Leu Ala Lys Glu Lys Thr Gln Thr Leu 180 185 190 His Lys Phe Ile Leu Leu Phe Ala Val Phe Asp Glu Gly Lys Ser Trp 195 200 205 His Ser Glu Thr Lys Asn Ser Leu Met Gln Asp Arg Asp Ala Ala Ser 210 215 220 Ala Arg Ala Trp Pro Lys Met His Thr Val Asn Gly Tyr Val Asn Arg 225 230 235 240 Ser Leu Pro Gly Leu Ile Gly Cys His Arg Lys Ser Val Tyr Trp His 245 250 255 Val Ile Gly Met Gly Thr Thr Pro Glu Val His Ser Ile Phe Leu Glu 260 265 270 Gly His Thr Phe Leu Val Arg Asn His Arg Gln Ala Ser Leu Glu Ile 275 280 285 Ser Pro Ile Thr Phe Leu Thr Ala Gln Thr Leu Leu Met Asp Leu Gly 290 295 300 Gln Phe Leu Leu Phe Cys His Ile Ser Ser His Gln His Asp Gly Met 305 310 315 320 Glu Ala Tyr Val Lys Val Asp Ser Cys Pro Glu Glu Pro Gln Leu Arg 325 330 335 Met Lys Asn Asn Glu Glu Ala Glu Asp Tyr Asp Asp Asp Leu Thr Asp 340 345 350 Ser Glu Met Asp Val Val Arg Phe Asp Asp Asp Asn Ser Pro Ser Phe 355 360 365 Ile Gln Ile Arg Ser Val Ala Lys Lys His Pro Lys Thr Trp Val His 370 375 380 Tyr Ile Ala Ala Glu Glu Glu Asp Trp Asp Tyr Ala Pro Leu Val Leu 385 390 395 400 Ala Pro Asp Asp Arg Ser Tyr Lys Ser Gln Tyr Leu Asn Asn Gly Pro 405 410 415 Gln Arg Ile Gly Arg Lys Tyr Lys Lys Val Arg Phe Met Ala Tyr Thr 420 425 430 Asp Glu Thr Phe Lys Thr Arg Glu Ala Ile Gln His Glu Ser Gly Ile 435 440 445 Leu Gly Pro Leu Leu Tyr Gly Glu Val Gly Asp Thr Leu Leu Ile Ile 450 455 460 Phe Lys Asn Gln Ala Ser Arg Pro Tyr Asn Ile Tyr Pro His Gly Ile 465 470 475 480 Thr Asp Val Arg Pro Leu Tyr Ser Arg Arg Leu Pro Lys Gly Val Lys 485 490 495 His Leu Lys Asp Phe Pro Ile Leu Pro Gly Glu Ile Phe Lys Tyr Lys 500 505 510 Trp Thr Val Thr Val Glu Asp Gly Pro Thr Lys Ser Asp Pro Arg Cys 515 520 525 Leu Thr Arg Tyr Tyr Ser Ser Phe Val Asn Met Glu Arg Asp Leu Ala 530 535 540 Ser Gly Leu Ile Gly Pro Leu Leu Ile Cys Tyr Lys Glu Ser Val Asp 545 550 555 560 Gln Arg Gly Asn Gln Ile Met Ser Asp Lys Arg Asn Val Ile Leu Phe 565 570 575 Ser Val Phe Asp Glu Asn Arg Ser Trp Tyr Leu Thr Glu Asn Ile Gln 580 585 590 Arg Phe Leu Pro Asn Pro Ala Gly Val Gln Leu Glu Asp Pro Glu Phe 595 600 605 Gln Ala Ser Asn Ile Met His Ser Ile Asn Gly Tyr Val Phe Asp Ser 610 615 620 Leu Gln Leu Ser Val Cys Leu His Glu Val Ala Tyr Trp Tyr Ile Leu 625 630 635 640 Ser Ile Gly Ala Gln Thr Asp Phe Leu Ser Val Phe Phe Ser Gly Tyr 645 650 655 Thr Phe Lys His Lys Met Val Tyr Glu Asp Thr Leu Thr Leu Phe Pro 660 665 670 Phe Ser Gly Glu Thr Val Phe Met Ser Met Glu Asn Pro Gly Leu Trp 675 680 685 Ile Leu Gly Cys His Asn Ser Asp Phe Arg Asn Arg Gly Met Thr Ala 690 695 700 Leu Leu Lys Val Ser Ser Cys Asp Lys Asn Thr Gly Asp Tyr Tyr Glu 705 710 715 720 Asp Ser Tyr Glu Asp Ile Ser Ala Tyr Leu Leu Ser Lys Asn Asn Ala 725 730 735 Ile Glu Pro Arg Glu Ile Thr Arg Thr Thr Leu Gln Ser Asp Gln Glu 740 745 750 Glu Ile Asp Tyr Asp Asp Thr Ile Ser Val Glu Met Lys Lys Glu Asp 755 760 765 Phe Asp Ile Tyr Asp Glu Asp Glu Asn Gln Ser Pro Arg Ser Phe Gln 770 775 780 Lys Lys Thr Arg His Tyr Phe Ile Ala Ala Val Glu Arg Leu Trp Asp 785 790 795 800 Tyr Gly Met Ser Ser Ser Pro His Val Leu Arg Asn Arg Ala Gln Ser 805 810 815 Gly Ser Val Pro Gln Phe Lys Lys Val Val Phe Gln Glu Phe Thr Asp 820 825 830 Gly Ser Phe Thr Gln Pro Leu Tyr Arg Gly Glu Leu Asn Glu His Leu 835 840 845 Gly Leu Leu Gly Pro Tyr Ile Arg Ala Glu Val Glu Asp Asn Ile Met 850 855 860 Val Thr Phe Arg Asn Gln Ala Ser Arg Pro Tyr Ser Phe Tyr Ser Ser 865 870 875 880 Leu Ile Ser Tyr Glu Glu Asp Gln Arg Gln Gly Ala Glu Pro Arg Lys 885 890 895 Asn Phe Val Lys Pro Asn Glu Thr Lys Thr Tyr Phe Trp Lys Val Gln 900 905 910 His His Met Ala Pro Thr Lys Asp Glu Phe Asp Cys Lys Ala Trp Ala 915 920 925 Tyr Phe Ser Asp Val Asp Leu Glu Lys Asp Val His Ser Gly Leu Ile 930 935 940 Gly Pro Leu Leu Val Cys His Thr Asn Thr Leu Asn Pro Ala His Gly 945 950 955 960 Arg Gln Val Thr Val Gln Glu Phe Ala Leu Phe Phe Thr Ile Phe Asp 965 970 975 Glu Thr Lys Ser Trp Tyr Phe Thr Glu Asn Met Glu Arg Asn Cys Arg 980 985 990 Ala Pro Cys Asn Ile Gln Met Glu Asp Pro Thr Phe Lys Glu Asn Tyr 995 1000 1005 Arg Phe His Ala Ile Asn Gly Tyr Ile Met Asp Thr Leu Pro Gly 1010 1015 1020 Leu Val Met Ala Gln Asp Gln Arg Ile Arg Trp Tyr Leu Leu Ser 1025 1030 1035 Met Gly Ser Asn Glu Asn Ile His Ser Ile His Phe Ser Gly His 1040 1045 1050 Val Phe Thr Val Arg Lys Lys Glu Glu Tyr Lys Met Ala Leu Tyr 1055 1060 1065 Asn Leu Tyr Pro Gly Val Phe Glu Thr Val Glu Met Leu Pro Ser 1070 1075 1080 Lys Ala Gly Ile Trp Arg Val Glu Cys Leu Ile Gly Glu His Leu 1085 1090 1095 His Ala Gly Met Ser Thr Leu Phe Leu Val Tyr Ser Asn Lys Cys 1100 1105 1110 Gln Thr Pro Leu Gly Met Ala Ser Gly His Ile Arg Asp Phe Gln 1115 1120 1125 Ile Thr Ala Ser Gly Gln Tyr Gly Gln Trp Ala Pro Lys Leu Ala 1130 1135 1140 Arg Leu His Tyr Ser Gly Ser Ile Asn Ala Trp Ser Thr Lys Glu 1145 1150 1155 Pro Phe Ser Trp Ile Lys Val Asp Leu Leu Ala Pro Met Ile Ile 1160 1165 1170 His Gly Ile Lys Thr Gln Gly Ala Arg Gln Lys Phe Ser Ser Leu 1175 1180 1185 Tyr Ile Ser Gln Phe Ile Ile Met Tyr Ser Leu Asp Gly Lys Lys 1190 1195 1200 Trp Gln Thr Tyr Arg Gly Asn Ser Thr Gly Thr Leu Met Val Phe 1205 1210 1215 Phe Gly Asn Val Asp Ser Ser Gly Ile Lys His Asn Ile Phe Asn 1220 1225 1230 Pro Pro Ile Ile Ala Arg Tyr Ile Arg Leu His Pro Thr His Tyr 1235 1240 1245 Ser Ile Arg Ser Thr Leu Arg Met Glu Leu Met Gly Cys Asp Leu 1250 1255 1260 Asn Ser Cys Ser Met Pro Leu Gly Met Glu Ser Lys Ala Ile Ser 1265 1270 1275 Asp Ala Gln Ile Thr Ala Ser Ser Tyr Phe Thr Asn Met Phe Ala 1280 1285 1290 Thr Trp Ser Pro Ser Lys Ala Arg Leu His Leu Gln Gly Arg Ser 1295 1300 1305 Asn Ala Trp Arg Pro Gln Val Asn Asn Pro Lys Glu Trp Leu Gln 1310 1315 1320 Val Asp Phe Gln Lys Thr Met Lys Val Thr Gly Val Thr Thr Gln 1325 1330 1335 Gly Val Lys Ser Leu Leu Thr Ser Met Tyr Val Lys Glu Phe Leu 1340 1345 1350 Ile Ser Ser Ser Gln Asp Gly His Gln Trp Thr Leu Phe Phe Gln 1355 1360 1365 Asn Gly Lys Val Lys Val Phe Gln Gly Asn Gln Asp Ser Phe Thr 1370 1375 1380 Pro Val Val Asn Ser Leu Asp Pro Pro Leu Leu Thr Arg Tyr Leu 1385 1390 1395 Arg Ile His Pro Gln Ser Trp Val His Gln Ile Ala Leu Arg Met 1400 1405 1410 Glu Val Leu Gly Cys Glu Ala Gln Asp Leu Tyr 1415 1420 

What is claimed is:
 1. A mutant factor VIII comprising a nonconservative amino acid substitution at one or more positions selected from the group consisting of Lys(380), Lys(512), Lys(523), Arg(527), Lys(556), Arg(562), Lys(570), Arg(571), and Lys(659); wherein the mutant factor VIII has reduced heparan sulfate proteoglycan (HSPG)-dependent, receptor-independent clearance; and wherein the mutant factor VIII has procoagulant activity.
 2. The mutant factor VIII of claim 1, wherein said mutant factor VIII has reduced receptor-dependent clearance.
 3. The mutant factor VIII of claim 2, which lacks the B domain.
 4. The mutant factor VIII of claim 3, wherein said nonconservative amino acid substitution is at one or more positions selected from the group consisting of Lys(380), Lys(512), Lys(523), Arg(527), Lys(556), Arg(562), Lys(570), and Lys(659).
 5. The mutant factor VIII of claim 4, wherein said nonconservative amino acid substitution is at one or more positions selected from the group consisting of Lys(380), Lys(512), Lys(523), Arg(527), Lys(556), Arg(562), and Lys(659).
 6. The mutant factor VIII of claim 5, wherein said nonconservative amino acid substitution is at one or more positions selected from the group consisting of Lys(380), Lys(512), Lys(523), Arg(527), Lys(556), and Lys(659).
 7. The mutant factor VIII of claim 6, wherein said nonconservative amino acid substitution is at one or more positions selected from the group consisting of Lys(380), Lys(512), Lys(523), Arg(527), and Lys(659).
 8. The mutant factor VIII of claim 3, wherein said nonconservative amino acid substitution is at one or more positions selected from the group consisting of Lys(523), Arg(527), Lys(556), Arg(562), Lys(570), and Arg(571).
 9. The mutant factor VIII of claim 3, comprising SEQ ID NO:5.
 10. A pharmaceutically acceptable composition comprising the mutant factor VIII of claim
 3. 11. A method of treating hemophilia which comprises administering to a patient in need thereof an effective amount of the mutant factor VIII of claim
 3. 12. The method of claim 11, which further comprises administering an effective amount of receptor-associated protein (RAP).
 13. A polynucleotide encoding the mutant factor VIII of claim
 3. 14. A method of treating hemophilia which comprises administering to a patient in need thereof an effective amount of the polynucleotide of claim
 13. 15. The method of claim 14, which further comprises administering an effective amount of a polynucleotide encoding RAP.
 16. The mutant factor VIII of claim 2, further comprising an amino acid substitution at one or more positions in the A2 domain; wherein the mutant factor VIII has reduced receptor-dependent clearance; and wherein the mutant factor VIII has procoagulant activity.
 17. The mutant factor VIII of claim 16, which lacks the B domain.
 18. The mutant factor VIII of claim 17, comprising an amino acid substitution at one or more of positions 484 to
 509. 19. The mutant factor VIII of claim 17, wherein said nonconservative amino acid substitution is at one or more positions selected from the group consisting of Lys(380), Lys(512), Lys(523), Arg(527), Lys(556), Arg(562), Lys(570), and Lys(659).
 20. The mutant factor VIII of claim 19, wherein said nonconservative amino acid substitution is at one or more positions selected from the group consisting of Lys(380), Lys(512), Lys(523), Arg(527), Lys(556), Arg(562), and Lys(659).
 21. The mutant factor VIII of claim 20, wherein said nonconservative amino acid substitution is at one or more positions selected from the group consisting of Lys(380), Lys(512), Lys(523), Arg(527), Lys(556), and Lys(659).
 22. The mutant factor VIII of claim 21, wherein said nonconservative amino acid substitution is at one or more positions selected from the group consisting of Lys(380), Lys(512), Lys(523), Arg(527), and Lys(659).
 23. The mutant factor VIII of claim 17, wherein said nonconservative amino acid substitution is at one or more positions selected from the group consisting of Lys(523), Arg(527), Lys(556), Arg(562), Lys(570), and Arg(571).
 24. The mutant factor VIII of claim 17, comprising SEQ ID NO:5.
 25. A pharmaceutically acceptable composition comprising the mutant factor VIII of claim
 17. 26. A method of treating hemophilia which comprises administering to a patient in need thereof an effective amount of the mutant factor VIII of claim
 17. 27. The method of claim 26, which further comprises administering an effective amount of RAP.
 28. A polynucleotide encoding the mutant factor VIII of claim
 17. 29. A method of treating hemophilia which comprises administering to a patient in need thereof an effective amount of the polynucleotide of claim
 28. 30. The method of claim 29, which further comprises administering an effective amount of a polynucleotide encoding RAP.
 31. The mutant factor VIII of claim 2, further comprising an amino acid substitution at one or more positions in the C2 domain; wherein the mutant factor VIII has reduced receptor-independent clearance; and wherein the mutant factor VIII has procoagulant activity.
 32. The mutant factor VIII of claim 31, which lacks the B domain.
 33. The mutant factor VIII of claim 32, comprising an amino acid substitution at one or more of positions 2303 to
 2332. 34. The mutant factor VIII of claim 33, comprising an amino acid substitution at one or more of positions 2311 to
 2319. 35. The mutant factor VIII of claim 32, wherein said nonconservative amino acid substitution is at one or more positions selected from the group consisting of Lys(380), Lys(512), Lys(523), Arg(527), Lys(556), Arg(562), Lys(570), and Lys(659).
 36. The mutant factor VIII of claim 35, wherein said nonconservative amino acid substitution is at one or more positions selected from the group consisting of Lys(380), Lys(512), Lys(523), Arg(527), Lys(556), Arg(562), and Lys(659).
 37. The mutant factor VIII of claim 36, wherein said nonconservative amino acid substitution is at one or more positions selected from the group consisting of Lys(380), Lys(512), Lys(523), Arg(527), Lys(556), and Lys(659).
 38. The mutant factor VIII of claim 37, wherein said nonconservative amino acid substitution is at one or more positions selected from the group consisting of Lys(380), Lys(512), Lys(523), Arg(527), and Lys(659).
 39. The mutant factor VIII of claim 32, wherein said nonconservative amino acid substitution is at one or more positions selected from the group consisting of Lys(523), Arg(527), Lys(556), Arg(562), Lys(570), and Arg(571).
 40. The mutant factor VIII of claim 32, comprising SEQ ID NO:5.
 41. A pharmaceutically acceptable composition comprising the mutant factor VIII of claim
 32. 42. A method of treating hemophilia which comprises administering to a patient in need thereof an effective amount of the mutant factor VIII of claim
 32. 43. The method of claim 42, which further comprises administering an effective amount of receptor associated protein (RAP).
 44. A polynucleotide encoding the mutant factor VIII of claim
 32. 45. A method of treating hemophilia which comprises administering to a patient in need thereof an effective amount of the polynucleotide of claim
 44. 46. The method of claim 45, which further comprises administering an effective amount of a polynucleotide encoding RAP.
 47. A mutant factor VIII comprising a nonconservative amino acid substitution at one or more positions in the A2 domain selected from the group consisting of Lys(380), Lys(512), Lys(523), Arg(527), Lys(556), Arg(562), Lys(570), Arg(571), and Lys(659); and an amino acid substitution selected from the group consisting of: (a) an amino acid substitution at one or more positions in the A2 domain; (b) an amino acid substitution at one or more positions in the C2 domain as numbered in SEQ ID NO:1; (c) an amino acid substitution at one or more positions in the A2 domain, and at one or more positions in the C2 domain as numbered in SEQ ID NO:1; wherein the mutant factor VIII has reduced heparan sulfate proteoglycan (HSPG)-dependent, receptor-independent clearance; and wherein the mutant factor VIII has procoagulant activity.
 48. The mutant factor VIII of claim 47, wherein the mutant factor VIII has reduced receptor-dependent and reduced receptor-independent clearance.
 49. The mutant factor VIII of claim 48, which lacks the B domain.
 50. The mutant factor VIII of claim 49, comprising SEQ ID NO:5.
 51. A pharmaceutically acceptable composition comprising the mutant factor VIII of claim
 49. 52. A method of treating hemophilia which comprises administering to a patient in need thereof an effective amount of the mutant factor VIII of claim
 49. 53. The method of claim 52, which further comprises administering an effective amount of RAP.
 54. A polynucleotide encoding the mutant factor VIII of claim
 49. 55. A method of treating hemophilia which comprises administering to a patient in need thereof an effective amount of the polynucleotide of claim
 54. 56. The method of claim 55, which further comprises administering an effective amount of a polynucleotide encoding RAP.
 57. A method of increasing the half-life of factor VIII, comprising substituting a nonconservative amino acid for a residue at one or more positions selected from the group consisting of Lys(380), Lys(512), Lys(523), Arg(527), Lys(556), Arg(562), Lys(570), Arg(571), and Lys(659); wherein the resulting factor VIII has reduced heparan sulfate proteoglycan (HSPG)-dependent, receptor-independent clearance; and wherein the resulting factor VIII has procoagulant activity.
 58. The method of claim 57, wherein the resulting factor VIII has reduced receptor-dependent clearance.
 59. The method of claim 58, which further comprises a method selected from the group consisting of: (a) method which comprises substituting an amino acid at one or more positions in the A2 domain; wherein the resulting factor VIII has reduced receptor-dependent clearance; and wherein the resulting factor VIII has procoagulant activity; (b) a method which comprises substituting an amino acid at one or more positions in the C2 domain; wherein the resulting factor VIII has reduced receptor-independent clearance; and wherein the resulting factor VIII has procoagulant activity; (c) a method which comprises administering to a patient in need thereof an effective amount of a fragment of RAP, wherein said fragment binds LRP; (d) a method comprising methods (a) and (b); (e) a method comprising methods (a) and (c); and (f) a method comprising methods (b) and (c).
 60. A mutant factor VIII comprising a nonconservative amino acid substitution at Arg(490) and at one or more positions selected from the group consisting of Lys(380), Lys(512), Lys(523), Arg(527), Lys(556), Arg(562), Lys(570), Arg(571), and Lys(659); wherein the mutant factor VIII has reduced heparan sulfate proteoglycan (HSPG)-dependent, receptor-independent clearance; and wherein the mutant factor VIII has procoagulant activity.
 61. The mutant factor VIII of claim 60, wherein said mutant factor VIII has reduced receptor-dependent clearance.
 62. The mutant factor VIII of claim 61, which lacks the B domain;
 63. The mutant factor VIII of claim 62, wherein said nonconservative amino acid substitutions are at Arg(490) and at one or more positions selected from the group consisting of Lys(380), Lys(512), Lys(523), Arg(527), Lys(556), Arg(562), Lys(570), and Lys(659).
 64. The mutant factor VIII of claim 63, wherein said nonconservative amino acid substitutions are at Arg(490) and at one or more positions selected from the group consisting of Lys(380), Lys(512), Lys(523), Arg(527), Lys(556), Arg(562), and Lys(659).
 65. The mutant factor VIII of claim 64, wherein said nonconservative amino acid substitutions are at Arg(490) and at one or more positions selected from the group consisting of Lys(380), Lys(512), Lys(523), Arg(527), Lys(556), and Lys(659).
 66. The mutant factor VIII of claim 65, wherein said nonconservative amino acid substitutions are at Arg(490) and at one or more positions selected from the group consisting of Lys(380), Lys(512), Lys(523), Arg(527), and Lys(659).
 67. The mutant factor VIII of claim 62, wherein said nonconservative amino acid substitutions are at Arg(490) and at Lys(523), Arg(527), Lys(556), Arg(562), Lys(570), and Arg(571).
 68. The mutant factor VIII of claim 62, comprising SEQ ID NO:5.
 69. A pharmaceutically acceptable composition comprising the mutant factor VIII of claim
 62. 70. A method of treating hemophilia which comprises administering to a patient in need thereof an effective amount of the mutant factor VIII of claim
 62. 71. The method of claim 70, which further comprises administering an effective amount of receptor-associated protein (RAP).
 72. A polynucleotide encoding the mutant factor VIII of claim
 62. 73. A method of treating hemophilia which comprises administering to a patient in need thereof an effective amount of the polynucleotide of claim
 72. 74. The method of claim 73, which further comprises administering an effective amount of a polynucleotide encoding RAP.
 75. The mutant factor VIII of claim 61, further comprising an amino acid substitution at one or more positions in the A2 domain; wherein the mutant factor VIII has reduced receptor-dependent clearance; and wherein the mutant factor VIII has procoagulant activity.
 76. The mutant factor VIII of claim 75, which lacks the B domain.
 77. The mutant factor VIII of claim 76, comprising an amino acid substitution at one or more of positions 484 to
 509. 78. The mutant factor VIII of claim 76, wherein said nonconservative amino acid substitutions are at Arg(490) and at one or more positions selected from the group consisting of Lys(380), Lys(512), Lys(523), Arg(527), Lys(556), Arg(562), Lys(570), and Lys(659).
 79. The mutant factor VIII of claim 78, wherein said nonconservative amino acid substitutions are at Arg(490) and at one or more positions selected from the group consisting of Lys(380), Lys(512), Lys(523), Arg(527), Lys(556), Arg(562), and Lys(659).
 80. The mutant factor VIII of claim 79, wherein said nonconservative amino acid substitutions are at Arg(490) and at one or more positions selected from the group consisting of Lys(380), Lys(512), Lys(523), Arg(527), Lys(556), and Lys(659).
 81. The mutant factor VIII of claim 80, wherein said nonconservative amino acid substitutions are at Arg(490) and at one or more positions selected from the group consisting of Lys(380), Lys(512), Lys(523), Arg(527), and Lys(659).
 82. The mutant factor VIII of claim 76, wherein said nonconservative amino acid substitutions are at Arg(490) and at Lys(523), Arg(527), Lys(556), Arg(562), Lys(570), and Arg(571).
 83. The mutant factor VIII of claim 76, comprising SEQ ID NO:5.
 84. A pharmaceutically acceptable composition comprising the mutant factor VIII of claim
 76. 85. A method of treating hemophilia which comprises administering to a patient in need thereof an effective amount of the mutant factor VIII of claim
 76. 86. The method of claim 85, which further comprises administering an effective amount of RAP.
 87. A polynucleotide encoding the mutant factor VIII of claim
 76. 88. A method of treating hemophilia which comprises administering to a patient in need thereof an effective amount of the polynucleotide of claim
 87. 89. The method of claim 88, which further comprises administering an effective amount of a polynucleotide encoding RAP.
 90. The mutant factor VIII of claim 61, further comprising an amino acid substitution at one or more positions in the C2 domain; wherein the mutant factor VIII has reduced receptor-independent clearance; and wherein the mutant factor VIII has procoagulant activity.
 91. The mutant factor VIII of claim 90, which lacks the B domain.
 92. The mutant factor VIII of claim 91, comprising an amino acid substitution at one or more of positions 2303 to
 2332. 93. The mutant factor VIII of claim 92, comprising an amino acid substitution at one or more of positions 2311 to
 2319. 94. The mutant factor VIII of claim 91, wherein said nonconservative amino acid substitutions are at Arg(490) and at one or more positions selected from the group consisting of Lys(380), Lys(512), Lys(523), Arg(527), Lys(556), Arg(562), Lys(570), and Lys(659).
 95. The mutant factor VIII of claim 94, wherein said nonconservative amino acid substitutions are at Arg(490) and at one or more positions selected from the group consisting of Lys(380), Lys(512), Lys(523), Arg(527), Lys(556), Arg(562), and Lys(659).
 96. The mutant factor VIII of claim 95, wherein said nonconservative amino acid substitutions are at Arg(490) and at one or more positions selected from the group consisting of Lys(380), Lys(512), Lys(523), Arg(527), Lys(556), and Lys(659).
 97. The mutant factor VIII of claim 96, wherein said nonconservative amino acid substitutions are at Arg(490) and at one or more positions selected from the group consisting of Lys(380), Lys(512), Lys(523), Arg(527), and Lys(659).
 98. The mutant factor VIII of claim 91, wherein said nonconservative amino acid substitutions are at Arg(490) and at Lys(523), Arg(527), Lys(556), Arg(562), Lys(570), and Arg(571).
 99. The mutant factor VIII of claim 91, comprising SEQ ID NO:5.
 100. A pharmaceutically acceptable composition comprising the mutant factor VIII of claim
 91. 101. A method of treating hemophilia which comprises administering to a patient in need thereof an effective amount of the mutant factor VIII of claim
 91. 102. The method of claim 101, which further comprises administering an effective amount of receptor associated protein (RAP).
 103. A polynucleotide encoding the mutant factor VIII of claim
 91. 104. A method of treating hemophilia which comprises administering to a patient in need thereof an effective amount of the polynucleotide of claim
 103. 105. The method of claim 104, which further comprises administering an effective amount of a polynucleotide encoding RAP.
 106. A mutant factor VIII, comprising a nonconservative amino acid substitution at Arg(490) and at one or more positions selected from the group consisting of Lys(380), Lys(512), Lys(523), Arg(527), Lys(556), Arg(562), Lys(570), Arg(571), and Lys(659) and an amino acid substitution selected from the group consisting of: (a) an amino acid substitution at one or more positions in the A2 domain; (b) an amino acid substitution at one or more positions in the C2 domain as numbered in SEQ ID NO:1; (c) an amino acid substitution at one or more positions in the A2 domain, and at one or more positions in the C2 domain as numbered in SEQ ID NO:1; wherein the mutant factor VIII has reduced heparan sulfate proteoglycan (HSPG)-dependent, receptor-independent clearance; and wherein the mutant factor VIII has procoagulant activity.
 107. The mutant factor VIII of claim 106, wherein the mutant factor VIII has reduced receptor-dependent and reduced receptor-independent clearance.
 108. The mutant factor VIII of claim 107, which lacks the B domain.
 109. The mutant factor VIII of claim 108, comprising SEQ ID NO:5.
 110. A pharmaceutically acceptable composition comprising the mutant factor VIII of claim
 108. 111. A method of treating hemophilia which comprises administering to a patient in need thereof an effective amount of the mutant factor VIII of claim
 108. 112. The method of claim 111, which further comprises administering an effective amount of RAP.
 113. A polynucleotide encoding the mutant factor VIII of claim
 108. 114. A method of treating hemophilia which comprises administering to a patient in need thereof an effective amount of the polynucleotide of claim
 113. 115. The method of claim 114, which further comprises administering an effective amount of a polynucleotide encoding RAP.
 116. A method of increasing the half-life of factor VIII, comprising substituting a nonconservative amino acid for a residue at Arg(490) and at one or more positions selected from the group consisting of Lys(380), Lys(512), Lys(523), Arg(527), Lys(556), Arg(562), Lys(570), Arg(571), and Lys(659); wherein the resulting factor VIII has reduced heparan sulfate proteoglycan (HSPG)-dependent, receptor-independent clearance; and wherein the resulting factor VIII has procoagulant activity.
 117. The method of claim 116, wherein the resulting factor VIII has reduced receptor-dependent clearance.
 118. The method of claim 117, which further comprises a method selected from the group consisting of (a) method which comprises substituting an amino acid at one or more positions in the A2 domain; wherein the resulting factor VIII has reduced receptor-dependent clearance; and wherein the resulting factor VIII has procoagulant activity; (b) a method which comprises substituting an amino acid at one or more positions in the C2 domain; wherein the resulting factor VIII has reduced receptor-independent clearance; and wherein the resulting factor VIII has procoagulant activity; (c) a method which comprises administering to a patient in need thereof an effective amount of a fragment of RAP, wherein said fragment binds LRP; (d) a method comprising methods (a) and (b); (e) a method comprising methods (a) and (c); and (f) a method comprising methods (b) and (c). 